NPIMap

Organization Active NPI

Circle the City

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1447765474
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CIRCLE THE CITY
Practice address
3333 E Van Buren St
Phoenix, AZ 85008-6812
Phone
(602) 776-0776
Fax
(602) 705-0567
NPI assigned
Dec 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
William Ellert, MD
Title
Chief Medical Officer
Phone
(602) 776-0776

Specialties & licenses 1

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

Addresses

Primary practice location

3333 E Van Buren St
Phoenix, AZ 85008-6812

Mailing address

300 W Clarendon Ave Ste 200
Phoenix, AZ 85013-3422
Phone (602) 776-0776

Other names 1

  • Circle the City Family Health Center - UMOM Campus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150609001984 AZ Part B Supplier - Clinic/Group Practice 3971824442 Receives reassigned benefits from 68 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ
O20180301001292 AZ Part A Provider - Federally Qualified Health Center (FQHC) 3971824442 Practice locations: Phoenix, AZ

Federally qualified health center certification: CCN 031968

Legal name
CIRCLE THE CITY
Doing business as
CIRCLE THE CITY FAMILY HEALTH CENTER - UMOM CAMPUS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2018
Last certification
Jan 26, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 2012 in AZ
Enrollment address
3333 E Van Buren St
Phoenix, AZ 85008-6812

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Circle the City12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

333 W Indian School Rd
Phoenix, AZ 85013
Phone (602) 248-0368

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
James T Nathan Individual Corporate Director Mar 23, 2015
Kelli Kathleen Smith Individual Corporate Director Jan 1, 2022
Roy Pringle Individual Corporate DirectorBoard Treasurer Oct 24, 2016
Adele Marie O Sullivan Individual Corporate OfficerChief Medical Officer, Founder Mar 8, 2008 34%
W-2 Managing EmployeeChief Medical Officer, Founder Mar 8, 2008 33%
Operational/Managerial ControlChief Medical Officer, Founder Mar 8, 2008 33%
Michael Zenobi Individual Corporate OfficerChief Financial Officer Dec 1, 2020 33%
W-2 Managing EmployeeCfo Dec 1, 2020 33%
Operational/Managerial ControlCfo Dec 1, 2020 33%
Ryan Andrew Odgers Individual Corporate Director Jan 1, 2022
Thomas Betlach Individual Corporate Director Jan 1, 2022
Kim Despres Individual Corporate OfficerChief Executive Officer Dec 1, 2020 33%
W-2 Managing EmployeeCeo Dec 1, 2020 33%
Operational/Managerial ControlCeo Dec 1, 2020 33%
Clayton Foster Individual Corporate Director Jan 1, 2022
Marc L Leib Individual Corporate Director Oct 24, 2016
Kathy Stein Individual Corporate Director May 22, 2017
Petrona Zickgraf Individual W-2 Managing EmployeeAssistant Controller Dec 1, 2020 23%
Lori Ann McClelland Individual Corporate Director Sep 27, 2010
Danielle Millard Individual Corporate Director Jan 1, 2022
Jaxinta Shaffer Individual Corporate Director Jan 1, 2022
Marion K. Kelly Individual Corporate Director Oct 24, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Parsons Family Health Center at Circle the CityPhoenix, AZ, CCN 031926 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 12, 2015
Circle the City Family Health Center, Downtown CampusPhoenix, AZ, CCN 031970 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Circle the City Medical Respite Center, Downtown CampusPhoenix, AZ, CCN 031978 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 2, 2018
Jan 2, 2018

Owned or controlled facilities with NPI records 5

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

  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1346755295

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1487033247

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1548775570

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1679954184

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1952948804

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1447765474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CLARENDON AVE STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133422",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 E VAN BUREN ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086812",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE THE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "ELLERT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "602-776-0776",
        "authorized_official_credential": "MD"
    },
    "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": "Circle the City Family Health Center - UMOM Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.