NPIMap

Organization Active NPI

Charles Drew Health Center

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1467818666
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHARLES DREW HEALTH CENTER
Practice address
1111 North 17TH Street
Omaha, NE 68102-4119
Phone
(402) 346-8401
Fax
(402) 453-2061
NPI assigned
Jan 5, 2016
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name
Ms. Tarsha Denise Jackson
Title
Chief Financial Officer
Phone
(402) 457-1215

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NE Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X NE
Community Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LC1500X NE

Addresses

Primary practice location

1111 North 17TH Street
Omaha, NE 68102-4119

Mailing address

2915 Grant Street
Omaha, NE 68111-3863
Phone (402) 451-3553

Other names 1

  • Charles Drew Homeless Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benson Community Health Center19 organizations share this tax ID, including this one
Part of
Benson Community Health Center

Other organizations with this tax ID 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1451952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1467818666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 GRANT STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NORTH 17TH STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681024119",
            "telephone_number": "402-346-8401",
            "fax_number": "402-453-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER",
        "enumeration_date": "2016-01-05",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Homeless Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles Drew Homeless Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.