NPIMap

Organization Active NPI

Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, WA
National Provider Identifier
1497176390
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
600625131 Issued in WA
Legal business name
FAMILY HEALTH CENTERS
Practice address
1015 Columbia Ave
Bridgeport, WA 98813
Phone
(509) 422-5700
Fax
(509) 422-7680
NPI assigned
Dec 18, 2013
Last updated
Jan 19, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Authorized official

Name
Jesus Hernandez
Title
Ceo
Phone
(509) 422-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 600625131 WA Primary

Addresses

Primary practice location

1015 Columbia Ave
Bridgeport, WA 98813

Mailing address

PO Box 1340
Okanogan, WA 98840
Phone (509) 422-5700

Other identifiers 1

IdentifierTypeStateIssuer
G000354600OtherWAMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140422002396 WA Part A Provider - Federally Qualified Health Center (FQHC) 9739076217 Practice locations: Bridgeport, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497176390. Details of each certification follow.

Federally qualified health center certification: CCN 501968

Legal name
FAMILY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2014
Last certification
Apr 9, 2014
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 1985 in WA
Enrollment address
1015 Columbia Avenue
Bridgeport, WA 98813

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Centers23 organizations share this tax ID, including this one
Part of
Family Health Centers

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 12

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

NameRoleSinceShare
Charlene a Burns Individual Corporate DirectorBoard Member Apr 1, 2019
George Thornton Individual Corporate DirectorBoard Member Mar 1, 2016
Caludia Lee Miller Individual Corporate DirectorBoard Member Jun 1, 2018
Teresa Trejo Individual Corporate DirectorBoard Member May 1, 2017
Jose Luna Individual Corporate DirectorBoard Member Jun 1, 2018
Ayde Garza Individual Corporate Director Jun 1, 2014
Cesilia Brooks Individual Corporate DirectorBoard Member Dec 1, 2015
Jesus Hernandez Individual Corporate OfficerCeo Apr 1, 2019
W-2 Managing EmployeeCeo Apr 1, 2019
Parker Parsons Individual Corporate DirectorBoard Member Oct 20, 2008 8%
Peter Morgan Individual Corporate DirectorBoard Member Jun 1, 2011 8%
Family Health Centers Organization, Okanogan, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Operational/Managerial Control Jan 1, 2014 100%
Charles Root Individual Corporate DirectorBoard Member Chair Mar 15, 2006 8%

Owners & managing parties with NPI records 5

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

  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Tonasket, WA
    • NPI 1184883449

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Omak, WA
    • NPI 1306005715

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Okanogan, WA
    • NPI 1609804392

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Brewster, WA
    • NPI 1629237482

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Twisp, WA
    • NPI 1679962401

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Family Health Centers TwispTwisp, WA, CCN 941000 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 1, 2015
May 1, 2015

Owned or controlled facilities with NPI records 1

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

  • Family Health Centers
    • Federally Qualified Health Center (FQHC)
    • Twisp, WA
    • NPI 1679962401

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1497176390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1340",
            "city": "OKANOGAN",
            "state": "WA",
            "postal_code": "98840",
            "telephone_number": "509-422-5700",
            "fax_number": "509-422-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 COLUMBIA AVE",
            "city": "BRIDGEPORT",
            "state": "WA",
            "postal_code": "98813",
            "telephone_number": "509-422-5700",
            "fax_number": "509-422-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH CENTERS",
        "enumeration_date": "2013-12-18",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JESUS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-422-5700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "600625131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "G000354600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, WA

Sources for this page

Verify at the official NPI Registry.