NPIMap

Organization Active NPI

Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clermont, FL
National Provider Identifier
1477199289
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS, INC.
Practice address
509 Cagan View Rd
Clermont, FL 34714-6405
Phone
(407) 905-8827
Fax
(407) 905-8998
NPI assigned
Nov 27, 2019
Last updated
Nov 27, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

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

Authorized official

Name
Maricruz Nieves
Title
Director of Billing & Managed Care
Phone
(407) 905-8827

Specialties & licenses 1

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

Addresses

Primary practice location

509 Cagan View Rd
Clermont, FL 34714-6405

Mailing address

110 S Woodland St
Winter Garden, FL 34787-3546
Phone (407) 905-8827

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200724001945 FL Part A Provider - Federally Qualified Health Center (FQHC) 4082515390 Practice locations: Clermont, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477199289. Details of each certification follow.

Federally qualified health center certification: CCN 681179

Legal name
COMMUNITY HEALTH CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 24, 2020
Last certification
Jul 24, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
509 Cagan View Rd
Clermont, FL 34714-6405

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
WNTR GRDN Family

Locations

509 Cagan View Rd
Clermont, FL 34714
Phone 40790588271028

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Nilmarie Zapata-Colon Individual Corporate Director2ND Vice Chairperson Aug 1, 2016 10%
Melissa Singh Individual Corporate Director1St Vice Chairperson Aug 1, 2016 10%
Mark W Dickinson Individual Corporate OfficerChief Financial Officer Mar 14, 2011
Debra Andree Individual Corporate OfficerPresident & Chief Executive Officer Jan 12, 2020
Operational/Managerial ControlPresident & Chief Executive Officer Jan 12, 2020 10%
Gisela Laurent Individual Corporate DirectorDirector on Board Feb 1, 2018 10%
Darryl Owens Individual Corporate DirectorDirector on Board Dec 1, 2024 10%
Kathy Rovito Individual Corporate DirectorDirector on Board Jul 1, 2024 10%
Felicia Davis Individual Corporate DirectorTreasurer on Board Feb 1, 2021 10%
Dale Price Individual Corporate DirectorDirector on Board May 1, 2018 10%
Jerry Kassab Individual Corporate DirectorChairperson on Board Jun 1, 2017 10%
Timothy Walker Individual Corporate DirectorSecretary on Board May 1, 2015 10%

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 4

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

FacilityTypeRoleSince
Community Health Centers, IncTavares, FL, CCN 681069 Federally qualified health center Operational/Managerial Control (100%) May 4, 2016
Community Health Centers, IncOrlando, FL, CCN 681099 Federally qualified health center Operational/Managerial Control (100%) Apr 25, 2017
Community Health Centers, IncClermont, FL, CCN 681120 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 19, 2018
Meadow Woods Health CenterOrlando, FL, CCN C11065 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 23, 2012

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1477199289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S WOODLAND ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873546",
            "telephone_number": "407-905-8827",
            "fax_number": "407-905-8998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 CAGAN VIEW RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347146405",
            "telephone_number": "407-905-8827",
            "fax_number": "407-905-8998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTERS, INC.",
        "enumeration_date": "2019-11-27",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "NIEVES",
        "authorized_official_first_name": "MARICRUZ",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING & MANAGED CARE",
        "authorized_official_telephone_number": "407-905-8827"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.