NPIMap

Organization Active NPI

Community Outreach Medical Center

  • Community/Behavioral Health Agency
  • Las Vegas, NV
National Provider Identifier
1457920068
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COMMUNITY OUTREACH MEDICAL CENTER
Practice address
1090 E Desert Inn Rd Ste 100
Las Vegas, NV 89109-2803
Phone
(702) 657-3873
NPI assigned
Jun 18, 2021
Organization subpart
Yes
Parent organization
COMMUNITY OUTREACH MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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

Authorized official

Name
Kema OgdenNPI 1861895039
Title
Executive Director
Phone
(702) 657-3873

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1090 E Desert Inn Rd Ste 100
Las Vegas, NV 89109-2803

Mailing address

1090 E Desert Inn Rd Ste 100
Las Vegas, NV 89109-2803
Phone (702) 657-3873

Other names 1

  • Community Outreach Medical Center-CCBHC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141231002003 NV Part B Supplier - Clinic/Group Practice 9830412634 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Community Outreach Medical

Locations

1090 E Desert Inn Rd
Ste 100
Las Vegas, NV 89109
Phone (702) 657-3873

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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": "1623974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1457920068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 E DESERT INN RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092803",
            "telephone_number": "702-657-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 E DESERT INN RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092803",
            "telephone_number": "702-657-3873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OUTREACH MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY OUTREACH MEDICAL CENTER",
        "enumeration_date": "2021-06-18",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "OGDEN",
        "authorized_official_first_name": "KEMA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "702-657-3873"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Outreach Medical Center-CCBHC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Outreach Medical Center-CCBHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.