Nevada Health Centers Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Jackpot, NV
NPI 1497833768 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1497833768
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- NEVADA HEALTH CENTERS INC
- Practice address
- 950 Lady Luck Drive
Box 628
Jackpot, NV 89825-0628 - Phone
- (775) 755-2500
- Fax
- (775) 755-2502
- NPI assigned
- Nov 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- NEVADA HEALTH CENTERS INC
Authorized official
- Name
- Walter B Davis
- Title
- Ceo
- Phone
- (775) 888-6610
Owners & managing parties with NPI records 24
Owned or controlled facilities with NPI records 13
Other NPIs on the same Medicare enrollment 34
Other NPIs with the same Medicare PAC ID 24
Corporate family (same tax ID) 33
Facilities with the same owner 13
Practitioners 39
-
Steven H Cerna, APRN
-
Madelaine Heidi Coquelet-Meyer, MFT, LCADC
-
Sarah Draves, APRN
-
Ashwitha Francis, MD
-
Rachel Elizabeth Grant, FNP-C
-
Gayle Harris, APRN
-
Amanda Lauren Horton, APRN
-
Mylinda Barrick Houser, LCSW
-
Sandra Fay Lewis, LCSW
-
Steve Lore, MD
-
Karina J Luera, DO
-
Elyse Muratore, MD
-
Ertha A Nanton, MD
-
Michael W Owens, MD
-
Amol Patel, MD
-
Rhianna Michelle Perez, MSN, FNP-C
-
Darren A Rahaman, MD
-
Jill Rathie, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D0981599 | Jackpot Community Health Center | Certificate of waiver | Jun 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NV
Federally qualified health center certification: CCN 291823
- Legal name
- NEVADA HEALTH CENTERS INC
- Doing business as
- JACKPOT COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 26, 2000
- Last certification
- Jun 26, 2000
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 22, 1992 in NV
- Enrollment address
- 950 Lady Luck Drive
Jackpot, NV 89825-0628
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Donald E Chaney |
Corporate Director |
Aug 1, 2012 | |
| Mary L Kieffer |
Corporate Director |
May 15, 2015 | |
| Alicia Y Barnes |
Corporate Director |
Aug 1, 2012 | |
| Gerald Ackerman |
Corporate Director |
Mar 1, 2011 | |
| Linda Bingaman |
Corporate Director |
May 15, 2015 | |
| Kathryn L Triplett |
Corporate Officer |
Oct 1, 2016 | 100% |
| W-2 Managing Employee |
Oct 1, 2016 | 100% | |
| Nevada Health Centers Inc |
5% Or Greater Direct Ownership Interest | Sep 1, 1999 | 100% |
| Maurice Washington |
Corporate Director |
May 15, 2015 | |
| Jared Carter |
Corporate Director |
Jun 5, 2009 | |
| Adriana Fralick |
Corporate Director |
May 15, 2015 | |
| Walter B Davis |
Corporate Officer |
Nov 26, 2012 | 100% |
| W-2 Managing Employee |
Nov 28, 2012 | 100% |
All facility ownership & control disclosures 13
| Facility | Type | Role | Since |
|---|---|---|---|
| Cambridge Family Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2013 |
| North Las Vegas Family Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | May 3, 2013 |
| Eastern Family Medical and Dental Center |
Federally qualified health center | Operational/Managerial Control (100%) | Jun 29, 2010 |
| Henderson Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 18, 2015 |
| Nevada Health Centers Carson City School Based |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 21, 2015 |
| Nevada Health Centers at Virginia City |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 29, 2015 |
| Nevada Children'S Health Project |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 26, 2018 |
| Nevada Health Centers at Enterprise |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 10, 2019 |
| Willow Street Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Aug 22, 2023 |
| Mobile Medical Services 1 |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Dec 29, 2023 |
| Mobile Dental Services 1 |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest | Dec 1, 2023 |
| Nellis Family Medical & Dental Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Oct 9, 2024 |
| Pahrump Family Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Oct 8, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040219000452 | NV | Part B Supplier - Clinic/Group Practice | 7113835307 |
Receives reassigned benefits from 65 practitioners 34 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV… |
| O20100730000166 | NV | Part a Provider - Federally Qualified Health Center (FQHC) | 7113835307 | Practice locations: Jackpot, NV |
National Provider Directory
- Tax ID family
- Nevada Rural Health Cen
- Part of
- Nevada Rural Health Cen
Locations
3325 Research Way
Carson City, NV 89706
Phone (775) 887-5140
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | NV | Yes |
Addresses
Primary practice location
950 Lady Luck Drive
Box 628
Jackpot, NV 89825-0628
Mailing address
3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DQ468C | Other | NV | MEDICARE ID - TYPE UNSPECIFIED |
| 1497833768 | Medicaid | NV |
Other names
- Jackpot Community Health Center
Other providers in Jackpot, NV
All providers in Jackpot, NV · Federally Qualified Health Center (FQHC) in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.