NPIMap

Organization Active NPI

Charles Drew Health Center Inc

Doing business as Charles Drew Health Center at Radius

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1477254415
Registry record updated Mar 17, 2023
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 INC
Doing business as
Charles Drew Health Center at Radius
Practice address
5030 Grand Ave
Omaha, NE 68104
Phone
(402) 457-1215
NPI assigned
Mar 16, 2023
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

5030 Grand Ave
Omaha, NE 68104

Mailing address

2915 Grant St
Omaha, NE 68111-3863
Phone (402) 457-1215

Other names 1

  • Charles Drew Health Center at Radius Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240607002244 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

Federally qualified health center certification: CCN D01002

Legal name
CHARLES DREW HEALTH CENTER INC
Doing business as
CHARLES DREW HEALTH CENTER INC AT RADIUS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 6, 2024
Last certification
Jun 6, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
5030 Grand Ave
Omaha, NE 68104-2367

Other NPIs with the same Medicare PAC ID 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2280075Charles Drew Health Center, Inc at Radius5030 Grand St, Omaha, NE 68104Provider-performed microscopyApr 11, 2027

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kenny McMorris Individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 20%
Corporate Director Jan 1, 2016 20%
W-2 Managing Employee Jan 1, 2016 20%
Andre Stringfellow Individual 5% Or Greater Direct Ownership InterestCfo Dec 1, 2023 40%

NPI Registry JSON

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1477254415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 GRANT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-457-1215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 GRAND AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68104",
            "telephone_number": "402-457-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER INC",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215"
    },
    "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": "Charles Drew Health Center at Radius",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles Drew Health Center at Radius",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.