Peoples Community Health Center, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PEOPLES COMMUNITY HEALTH CENTER, INC.

Practice address

1370 Odenton Rd
Odenton, MD 21113-1503

Phone

(410) 467-6040

Fax

(443) 743-2866

NPI assigned

Aug 11, 2010

Organization subpart

No

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

Authorized official

Name

Stacy Fruhling

Title

Ceo

Phone

(410) 467-6040

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• ODENTON HEALTH CENTER Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 211882

Legal name

ODENTON HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 3, 2011

Last certification

Nov 3, 2011

Ownership / control type

For profit – corporation

Facility address

1370 Odenton Road
Odenton, MD 21113

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401667200000",
    "number": "1447565783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33109",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212180401",
            "telephone_number": "410-467-6040",
            "fax_number": "443-743-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 ODENTON RD",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211131503",
            "telephone_number": "410-467-6040",
            "fax_number": "443-743-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLES COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2014-06-02",
        "status": "A",
        "authorized_official_last_name": "FRUHLING",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-467-6040"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910561100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CROSS BLUE SHIELD",
            "identifier": "H649",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ODENTON HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Odenton, MD
• Providers in Odenton, MD by specialty
• Federally Qualified Health Center (FQHC) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.