NPIMap

Organization Active NPI

Community Health Care, Inc

Doing business as Edgerton Women's Health Center - Dental

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
National Provider Identifier
1427418276
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE, INC
Doing business as
Edgerton Women's Health Center - Dental
Practice address
1510 E Rusholme St
Davenport, IA 52803-2463
Phone
(563) 336-3000
Fax
(563) 336-3125
NPI assigned
Mar 7, 2016
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas J Bowman
Title
Ceo
Phone
(563) 336-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1510 E Rusholme St
Davenport, IA 52803-2463

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other identifiers 2

IdentifierTypeStateIssuer
PENDINGMedicaidIA
PENDINGMedicaidIL

Other names 1

  • Edgerton Women's Health Center - Dental Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317000776 IA Part B Supplier - Clinic/Group Practice 9830008895 Receives reassigned benefits from 78 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, IA; Muscatine, IA; Clinton, IA
O20160405000948 IA Part A Provider - Federally Qualified Health Center (FQHC) 9830008895 Practice locations: Davenport, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427418276. Details of each certification follow.

Federally qualified health center certification: CCN 161867

Legal name
COMMUNITY HEALTH CARE INC
Doing business as
EDGERTON WOMEN'S HEALTH CENTER - DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 2016
Last certification
Apr 1, 2016
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
1510 E Rusholme St
Davenport, IA 52803-2463

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0387568Community Health Care, Inc - Edgerton1510 E Rusholme Street, Davenport, IA 52803Provider-performed microscopyMay 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Care Group of Illinois18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sarah Moore Individual Corporate DirectorBoard Member Nov 3, 2020
Anita Gomez-Jones Individual Corporate DirectorBoard Member Jun 5, 2018
Thomas John Bowman Individual Corporate OfficerCeo Mar 8, 2016
W-2 Managing Employee Mar 8, 2016
Kevin Hagedorn Individual Corporate OfficerCfo Mar 8, 2016
Kristin Humphries Individual Corporate DirectorBoard Member Nov 23, 2023
Lisa Randolph Individual Corporate DirectorBoard Member Nov 5, 2019
Vaden Spurlock Individual Corporate DirectorBoard Member Nov 3, 2020
Timothy Dahl Individual Corporate DirectorBoard Member Nov 1, 2023
Todd Wilson Individual Corporate DirectorBoard Member Nov 3, 2020
David Joseph Helscher Individual Corporate DirectorBoard Member Jul 2, 2019
Phyllis M Mullett Individual Corporate DirectorBoard Member Nov 5, 2019
Katie Spain Individual Corporate DirectorBoard Member Nov 5, 2019
Anthony Schwenke Individual Corporate DirectorBoard Member Sep 5, 2017
Laiken Guldenpfenning Individual Corporate DirectorBoard Member Nov 23, 2023
Luekinna Hodges Individual Corporate DirectorBoard Member Nov 23, 2023
Jordan Kaplan Individual Corporate DirectorBoard Member Mar 8, 2016
Daniel Lopez Individual Corporate DirectorBoard Member Nov 23, 2023
Nana Ouro-Agoro Individual Corporate DirectorBoard Member Nov 22, 2023
Darryl Dopson Individual Corporate DirectorBoard Member Nov 1, 2018

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1427418276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032463",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-336-3000"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgerton Women's Health Center - Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.