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Community Health Center Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Clinton, CT

NPI 1447435862 · NPPES record last updated Oct 30, 2012

Key facts

NPI
1447435862
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER INC
Practice address
114 E Main St
Clinton, CT 06413-2112
Phone
(860) 664-0787
Fax
(860) 664-1982
NPI assigned
Jan 3, 2008
Organization subpart
No

Authorized official

Name
Ms. Bain Patrie
Title
Credentialing Specialist
Phone
(860) 347-6971

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 13

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

Corporate family (same tax ID) 29

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

View all 29

Practitioners 149

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 149

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CT

Federally qualified health center certification: CCN 071842

Legal name
COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2008
Last certification
Mar 31, 2008
Ownership / control type
Non-profit – church related
Organization structure
Corporation · Non-profit
Incorporated
May 1, 1972 in CT
Enrollment address
114E Main St
Clinton, CT 64132112

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Gary Reid
Individual 		Corporate Director Sep 1, 2000
Mark Bonney
Individual 		Corporate Director Sep 1, 2000
Angela Anthony
Individual 		Corporate Director Sep 1, 2000
Mark Masselli
Individual 		5% Or Greater Direct Ownership Interest
President/Ceo		 May 1, 1972 50%
Corporate Officer
President/Ceo		 Sep 1, 2000 50%
Corporate Director Sep 1, 2000
W-2 Managing Employee Sep 1, 2000
Donald J Case
Individual 		Corporate Director Sep 1, 2000
David Vance
Individual 		Corporate Director Sep 1, 2000
Aida Heredia
Individual 		Corporate Director Sep 1, 2000
W-2 Managing Employee Sep 1, 2000
Terry Danaher
Individual 		Corporate Director Sep 1, 2000
Maragaret Flinter
Individual 		5% Or Greater Direct Ownership Interest
SVP/Clinical Director		 Sep 1, 2000 50%
Corporate Officer
SVP/Clinical Director		 Sep 1, 2000 100%
Corporate Director
SVP/Clinical Director		 Sep 1, 2000 50%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Center of Danbury
Danbury, CT · CCN 071849		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2000
Community Health Center of Enfield
Enfield, CT · CCN 071850		 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2000

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080219000158 CT Part a Provider - Federally Qualified Health Center (FQHC) 0547169138 Practice locations: Clinton, CT

National Provider Directory

Tax ID family
Community Health Center (30 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 0337 CT
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X 0337 CT
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

114 E Main St
Clinton, CT 06413-2112

Mailing address

575 Main St FL 2
Attn: Credentialing DPT
Middletown, CT 06457-2845
Phone (860) 347-6971

Other identifiers

IdentifierTypeStateIssuer
004236346MedicaidCT
004236338MedicaidCT

Other providers in Clinton, CT

All providers in Clinton, CT · Federally Qualified Health Center (FQHC) in Connecticut

Sources for this page

Verify at the official NPI Registry.