West Cecil Health Center Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Havre de Grace, MD
NPI 1437697273 · NPPES record last updated Aug 13, 2024
Key facts
- NPI
- 1437697273
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WEST CECIL HEALTH CENTER INC.
- Practice address
- 253 Lewis LN Ste 202
Havre de Grace, MD 21078-3756 - Phone
- (443) 502-7060
- Fax
- (410) 378-9922
- NPI assigned
- Feb 1, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- WEST CECIL HEALTH CENTER
Authorized official
- Name
- Mr. John Ragnar Ness
- Title
- Ceo/Cfo
- Phone
- (410) 378-9696
Owners & managing parties with NPI records 2
-
Arsalan Sheikh, D.O.
-
Mozella Williams, MD
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 2
Practitioners 24
-
Gemma Melanie Armstrong, D.O.
-
Jennifer Bailey, FNP-BC, PMHNP-BC
-
Kathy Lynn Bristow, CRNP-PMHBC
-
Karen Glab-Bivens, LCSW-C
-
Kericia Hall-Chambers, CRNP
-
Kerry Lynn Hospelhorn, LCSW-C
-
Jessica M Koontz-Ferrera, LCSW-C
-
Elizabeth Ann Montemurro, O. D.
-
Olamipo Odebode, DNP PMHNP-BC
-
Rachel Dawn Priebe, LCSW-C
-
Jessica Ann Russell, CRNP- FAMILY
-
Ruth Laine Scott-Nelson, CRNP-F- PMH
-
Margaret Webb, CRNP-PMH
-
Amy Wiley, FNP-C
-
Mozella Williams, MD
-
Stephanie Nicole Coen, FNP-C
-
Afshan Jabeen Khalid, MENTAL HEALTH COUNSE
-
Jan Marie Brewer, LCSW-C
-
Tiffanie Fontaine, LCSW-C
-
Grant J Walter, LCSW C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2127219 | WCHC Beacon Health Center | Certificate of waiver | Jan 21, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD
Federally qualified health center certification: CCN 211912
- Legal name
- WEST CECIL HEALTH CENTER INC.
- Doing business as
- BEACON HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 3, 2017
- Last certification
- Mar 3, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 6, 2006 in MD
- Enrollment address
- 253 Lewis LN
Ste 202
Havre de Grace, MD 21078-3756
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Elyse Murray |
Corporate Director |
Jun 11, 2019 | |
| Nikolaos Brusio |
Corporate Officer |
May 20, 2024 | |
| W-2 Managing Employee |
May 20, 2024 | ||
| Jeffrey K Coale |
Corporate Director |
Jun 11, 2024 | |
| John Ragnar Ness |
W-2 Managing Employee |
Aug 4, 2017 | |
| Sarah Snyder |
Corporate Director |
Jun 28, 2022 | |
| Mozella Williams |
Corporate Officer |
Mar 4, 2020 | |
| W-2 Managing Employee |
Mar 4, 2020 | ||
| Laura Hannan |
Corporate Director |
Jan 24, 2023 | |
| Arthur Grace |
Corporate Director |
Jun 24, 2020 | |
| Melanie Horning |
Corporate Director |
Sep 12, 2023 | |
| Arsalan Sheikh |
Corporate Director |
Dec 10, 2024 | |
| Morgan McRay |
Corporate Director |
Apr 9, 2024 | |
| Jenni Hammer |
Corporate Officer |
Jun 11, 2024 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| West Cecil Health Center Inc. |
Federally qualified health center | Other | Mar 3, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140318000266 | MD | Part B Supplier - Clinic/Group Practice | 6709964398 |
Receives reassigned benefits from 24 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Conowingo, MD; Elkton, MD; Havre de Grace, MD |
| O20170303000146 | MD | Part a Provider - Federally Qualified Health Center (FQHC) | 6709964398 | Practice locations: Havre de Grace, MD |
National Provider Directory
- Part of
- West Cecil Health Center Inc
Locations
253 Lewis Ln
Ste 202
Havre de Grace, MD 21078
Phone (443) 502-7060
Interoperability endpoints
- https://api.platform.athenahealth.com/6703/brand/1/csg/1/fhir/r4
- https://fhir4.healow.com/fhir/r4/DAHIAD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
253 Lewis LN Ste 202
Havre de Grace, MD 21078-3756
Mailing address
PO Box 99
Conowingo, MD 21918-0099
Phone (410) 378-9696
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 414977700 | Medicaid | MD |
Other names
- Beacon Health Center
Other providers in Havre de Grace, MD
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All providers in Havre de Grace, MD · Federally Qualified Health Center (FQHC) in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.