Community Health Alliance
Organization Active NPI Federally Qualified Health Center (FQHC) · Reno, NV
NPI 1407463540 · NPPES record last updated Jan 25, 2024
Key facts
- NPI
- 1407463540
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH ALLIANCE
- Practice address
- 680 S Rock Blvd
Reno, NV 89502-4113 - Phone
- (775) 329-6300
- NPI assigned
- Sep 23, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY HEALTH ALLIANCE
Authorized official
- Name
- Jennifer Wheeler
- Title
- Cco
- Phone
- (775) 329-6300
Owners & managing parties with NPI records 2
-
Daniel Spogen, M.D.
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 8
Practitioners 56
-
Nephtali Barrera, MD
-
Andrea Samantha Lozano, DNP-FNP
-
Joshua Tartakoff, D.O
-
Marie Gracia Bare, NP-C
-
Paul Reese Nevis, LMSW
-
Kamariah M Baker, PA
-
Dilpreet Bal, PA-C
-
Lori Connell, FNP-C
-
Kelly Marie Dawley, APRN
-
Carly Alyssa Di Lillo, PA-C
-
Alexis Dunn, PA-C
-
Dylan Greenblat, MD
-
Stephanie Gstettenbauer, M.A.
-
Ariel Ikesakes, PA-C
-
William Lara, PA-C
-
James Lee, PA-C
-
Thoann Ngoc Lee, PA-C
-
Samantha Lilla, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV
Federally qualified health center certification: CCN 291868
- Legal name
- COMMUNITY HEALTH ALLIANCE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 7, 2020
- Last certification
- Oct 7, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 31, 1992 in NV
- Enrollment address
- 680 S Rock Blvd
Reno, NV 89502-4113
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel R Spogen |
Corporate Director |
Aug 1, 2016 | |
| Bayo K Curry-Winchell |
Corporate Director |
Jan 1, 2022 | |
| Matthew Thorton |
Corporate Director |
Aug 1, 2016 | |
| Mathew Work |
Corporate Director |
Feb 1, 2022 | |
| Nathan Dupree |
Corporate Director |
Sep 1, 2023 | |
| Sam King |
Corporate Officer |
May 1, 2024 | |
| Oscar Dario Delgado |
Corporate Officer |
Jul 1, 2021 | |
| Noemi Gomez |
Corporate Director |
Dec 1, 2022 | |
| Paul R Parent |
Corporate Director |
Feb 1, 2011 | |
| Jennifer Wheeler |
Corporate Officer |
Jan 1, 2020 | |
| W-2 Managing Employee |
Jan 1, 2020 | ||
| Laura Martinez |
Corporate Officer |
Sep 1, 2020 | |
| Alexsis Adams |
Corporate Director |
Apr 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040701000827 | NV | Part B Supplier - Clinic/Group Practice | 3577540160 |
Receives reassigned benefits from 68 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Reno, NV; Sun Valley, NV; Sparks, NV |
| O20100709000663 | NV | Part a Provider - Federally Qualified Health Center (FQHC) | 3577540160 |
1 other NPI on this enrollment Practice locations: Reno, NV |
National Provider Directory
- Part of
- H a W C Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
680 S Rock Blvd
Reno, NV 89502-4113
Mailing address
680 S Rock Blvd
Reno, NV 89502-4113
Phone (775) 329-6300
Other names
- Medical Mobile Van
Other providers in Reno, NV
- Community First LLC
- Community Health Alliance
- Community Health Alliance
- Community Health Alliance
- Community Health Alliance
- Community Health Alliance
- Community Health Alliance
- Community Health Alliance
- Community Hospice of Northern Nevada
- Community Mental Health Inc
All providers in Reno, NV · Federally Qualified Health Center (FQHC) in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.