NPIMap

Organization Active NPI

Suncoast Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Tampa, FL
National Provider Identifier
1477979748
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNCOAST COMMUNITY HEALTH CENTERS, INC
Practice address
7728 Palm River Rd
Tampa, FL 33619-4215
Phone
(813) 349-7567
NPI assigned
Mar 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Authorized official

Name
Robert R Rodriguez
Title
Cfo
Phone
(813) 349-7563

Specialties & licenses 1

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

Addresses

Primary practice location

7728 Palm River Rd
Tampa, FL 33619-4215

Mailing address

13110 Elk Mountain Dr
Riverview, FL 33579-7182
Phone (813) 349-7588

Other names 1

  • Palm River Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140731001204 FL Part A Provider - Federally Qualified Health Center (FQHC) 3870402548 Practice locations: Tampa, FL

Federally qualified health center certification: CCN 101164

Legal name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2014
Last certification
Jul 31, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1977 in FL
Enrollment address
7728 Palm River Rd
Tampa, FL 33619-4215

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Roberto Morales Individual Corporate OfficerCoo Jan 1, 2025
W-2 Managing EmployeeCoo Jan 1, 2025
Operational/Managerial ControlCoo Jan 1, 2025
Gwendolyn Smalley Individual Corporate DirectorBoard Member Jan 1, 2025
Bradley Herremans Individual Corporate OfficerCeo Jan 1, 2025
W-2 Managing EmployeeAd; Jan 1, 2025
Operational/Managerial ControlCeo Jan 1, 2025
Nancy Hewlett Individual Corporate DirectorBoard Member Jan 1, 2025
Brian Shaub Individual Corporate OfficerChief Medical Director Jan 1, 2025
W-2 Managing EmployeeMD; Jan 1, 2025
Operational/Managerial ControlChief Medical Director Jan 1, 2025
Carlos Garcia Individual Corporate DirectorBoard Vice Chair Jan 1, 2025
Susan Peltz Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial ControlCfo Jan 3, 2025
Elbert Odor Individual Corporate DirectorBoard Member Jan 1, 2025
Nelson Ramos Individual Corporate DirectorBoard Member Jan 1, 2025
Maria Consuela Huber Individual Corporate DirectorBoard Treasurer Jan 1, 2025
Krystal Lockhart Individual Corporate DirectorBoard Secretary Jan 1, 2025
Ivon Ruz Individual Corporate DirectorBoard Member Jan 1, 2025
Rich Glorioso Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1477979748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 ELK MOUNTAIN DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797182",
            "telephone_number": "813-349-7588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7728 PALM RIVER RD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336194215",
            "telephone_number": "813-349-7567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "813-349-7563"
    },
    "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": "Palm River Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.