NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as Choptank Mobile Van #3 Medical

  • Federally Qualified Health Center (FQHC)
  • Chestertown, MD
National Provider Identifier
1487333035
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Doing business as
Choptank Mobile Van #3 Medical
Practice address
601 High St
Chestertown, MD 21620-1124
Phone
(410) 479-5772
Fax
(410) 479-8397
NPI assigned
Jul 12, 2023
Last updated
Jul 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CHOPTANK COMMUNITY HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Sara Rich
Title
Ceo
Phone
(410) 479-4306

Specialties & licenses 1

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

Addresses

Primary practice location

601 High St
Chestertown, MD 21620-1124

Mailing address

601 High St
Chestertown, MD 21620-1124
Phone (410) 479-5772

Other names 1

  • Choptank Mobile Van #3 Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231004000097 MD Part A Provider - Federally Qualified Health Center (FQHC) 0648189274 Practice locations: Chestertown, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487333035. Details of each certification follow.

Federally qualified health center certification: CCN 211073

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 18, 2023
Last certification
Sep 18, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Enrollment address
601 High St
Chestertown, MD 21620-1124

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Caroline Health Service103 organizations share this tax ID, including this one
Part of
Caroline Health Service

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Benjamin Cottle Individual Corporate OfficerCfo Jul 16, 2018
Jennifer W Yost Individual Corporate DirectorBoard Member Feb 1, 2015
Sara K Rich Individual Corporate OfficerCeo Jun 29, 2015
Rebecca Loukides Individual Corporate DirectorBoard Member Aug 1, 2016
Carlene L Wilson Individual Corporate DirectorBoard Member Sep 1, 2022
Anna Sierra Individual Corporate DirectorBoard Member Feb 28, 2020
Rosemary L Ramsey Individual Corporate DirectorBoard Member May 31, 2022
Savannah S Winston Individual Corporate DirectorBoard Member Feb 28, 2020
Joyneka L Moals Individual Corporate DirectorBoard Member Jul 28, 2022
Sandra O'Neill Individual Corporate DirectorBoard Member May 23, 2019
Wayne Cole Individual Corporate DirectorBoard Member Jan 31, 2020
Matthew R Peters Individual Corporate DirectorBoard Member Apr 1, 2015
Lorenzo L Hughes Individual Corporate DirectorBoard Member Mar 25, 2019
Kimberly R Love Individual W-2 Managing EmployeeFinance Director Feb 22, 2002
Austin N Webster Individual Corporate DirectorBoard Member Jan 1, 2010
Sara B Visintainer Individual Corporate DirectorBoard Member Feb 1, 2015

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": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1487333035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 HIGH ST",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201124",
            "telephone_number": "410-479-5772",
            "fax_number": "410-479-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 HIGH ST",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201124",
            "telephone_number": "410-479-5772",
            "fax_number": "410-479-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-479-4306"
    },
    "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": "Choptank Mobile Van #3 Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chestertown, MD

Sources for this page

Verify at the official NPI Registry.