NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

Doing business as Hawkins Medical Center

  • Federally Qualified Health Center (FQHC)
  • Ontario, OH
National Provider Identifier
1427492271
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
Hawkins Medical Center
Practice address
2131 Park Ave W
Suite 200
Ontario, OH 44906-1226
Phone
(419) 526-7869
Fax
(419) 522-0493
NPI assigned
Apr 23, 2013
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Mr. Peggy Anderson
Title
Ceo
Phone
(419) 522-6191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2131 Park Ave W
Suite 200
Ontario, OH 44906-1226

Mailing address

1404 Park Ave W
Ste 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other names 1

  • Hawkins Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000770 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, OH; Mansfield, OH; Ontario, OH
O20130813000355 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Mansfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427492271. Details of each certification follow.

Federally qualified health center certification: CCN 361030

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
HAWKINS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 20, 2013
Last certification
Aug 20, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
2131 Park W Ave 200
Mansfield, OH 44906-1226

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mansfield Family Health 226 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

2131 Park Ave W
Ste 200
Ontario, OH 44906
Phone (419) 525-6730

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate OfficerCfo Jul 26, 2021
Corporate Director Jul 26, 2021
W-2 Managing EmployeeCfo Jul 26, 2021
James Dolan Individual Corporate DirectorBoard Member Jul 26, 2021
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 26, 2021
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Feb 27, 1971
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 26, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Amber Wertman Individual Corporate DirectorBoard Member Jul 26, 2021
Cody Albert Individual Corporate DirectorBoard Member Jul 26, 2021
Peggy S Anderson Individual Corporate OfficerCeo Jul 26, 2021
Corporate DirectorBoard Member - P Jul 26, 2021
W-2 Managing EmployeeCeo Jul 26, 2021
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Jul 26, 2021
Corporate Director Jul 26, 2021
W-2 Managing EmployeeCoo Jul 26, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 8

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": "1366675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1427492271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "STE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-522-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 PARK AVE W",
            "address_2": "SUITE 200",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449061226",
            "telephone_number": "419-526-7869",
            "fax_number": "419-522-0493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-23",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-522-6191",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawkins Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hawkins Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ontario, OH

Sources for this page

Verify at the official NPI Registry.