NPIMap

Organization Active NPI

Community Clinical Services, Inc.

Doing business as Second Street Health Center

  • Federally Qualified Health Center (FQHC)
  • Auburn, ME
National Provider Identifier
1487080958
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CLINICAL SERVICES, INC.
Doing business as
Second Street Health Center
Practice address
60 Second St
Auburn, ME 04210-6853
Phone
(207) 755-3456
Fax
(207) 755-3457
NPI assigned
Sep 17, 2013
Last updated
Oct 22, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CLINICAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Authorized official

Name
Coleen L Elias
Title
Ceo/Cfo
Phone
(207) 513-3897

Specialties & licenses 1

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

Addresses

Primary practice location

60 Second St
Auburn, ME 04210-6853

Mailing address

PO Box 95000 LBX 7660
Philadelphia, PA 19195-0001
Phone (207) 777-8202

Other names 1

  • Second Street Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220128001646 ME Part A Provider - Federally Qualified Health Center (FQHC) 0042101099 Practice locations: Auburn, ME

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1487080958. Details of each certification follow.

Federally qualified health center certification: CCN 201956

Legal name
COMMUNITY CLINICAL SERVICES INC
Doing business as
CCS SECOND STREET HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2022
Last certification
Jan 6, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 19, 1985 in ME
Enrollment address
60 Second St
Auburn, ME 42106853

Federally qualified health center certification: CCN 201906

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SECOND STREET HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2013
Last certification
Nov 12, 2013
Ownership / control type
For profit – corporation
Facility address
60 Second Street
Auburn, ME 04210

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Community Clinical Services Inc23 organizations share this tax ID, including this one
Part of
Community Clinical Services Inc

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Frances a Rodgers Individual Corporate Director May 24, 2021 11.11%
Coleen L Elias Individual Corporate OfficerCeo/Cfo Mar 11, 2020
W-2 Managing EmployeeCeo/Cfo Mar 11, 2021
Operational/Managerial ControlCeo/Cfo Mar 11, 2020
Elizabeth a Keene Individual Corporate Director Jan 22, 2015 11.11%
Paige a Hagerstrom Individual Corporate Director May 23, 2016 11.11%
Hawo a Abdille Individual Corporate OfficerVice Chair Jun 28, 2021 11.11%
Corporate DirectorVice Chair May 1, 2020 11.11%
Abdi Abdalla Individual Corporate Director Apr 25, 2022 11.11%
Lynn Ward Individual Corporate OfficerChairperson Jun 30, 2020 11.11%
Corporate DirectorChairperson Sep 24, 2018 11.11%
Andrew Lunn Individual Corporate OfficerSecretary Jan 23, 2023 11.11%
Corporate DirectorSecretary Jan 23, 2023 11.11%
Laura L Minkowsky-Gormley Individual Corporate OfficerTreasurer Jun 25, 2018 11.11%
Corporate DirectorTreasurer Jun 25, 2018 11.11%
Abdulkerim M Said Individual Corporate Director Nov 16, 2020 11.11%

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.

NPI Registry JSON

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1487080958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000 LBX 7660",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191950001",
            "telephone_number": "207-777-8202",
            "fax_number": "207-783-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 SECOND ST",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "042106853",
            "telephone_number": "207-755-3456",
            "fax_number": "207-755-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CLINICAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CLINICAL SERVICES, INC.",
        "enumeration_date": "2013-09-17",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "ELIAS",
        "authorized_official_first_name": "COLEEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/CFO",
        "authorized_official_telephone_number": "207-513-3897"
    },
    "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": "Second Street Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Second Street Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Auburn, ME

Sources for this page

Verify at the official NPI Registry.