NPIMap

Organization Active NPI

Family Health Services of Erie County

  • Federally Qualified Health Center (FQHC)
  • Collins, OH
National Provider Identifier
1508645649
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Practice address
3841 US Rte 20 E
Collins, OH 44826
Phone
(419) 502-2800
Fax
(419) 502-2821
NPI assigned
Sep 27, 2023
Last updated
Sep 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

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

Authorized official

Name
David Tatro
Title
Chief Executive Officer
Phone
(419) 502-2822

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

3841 US Rte 20 E
Collins, OH 44826

Mailing address

1912 Hayes Ave Ste D
Sandusky, OH 44870-4736
Phone (419) 502-2800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231108000138 OH Part A Provider - Federally Qualified Health Center (FQHC) 0749345296 Practice locations: Collins, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508645649. Details of each certification follow.

Federally qualified health center certification: CCN D21021

Legal name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 6, 2023
Last certification
Nov 6, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 2008 in OH
Enrollment address
3841 US Hwy 20
Collins, OH 44826-9513

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Family Health Services of Erie County21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

3851 US Hwy 20
Collins, OH 44826

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Brent William Burkey Individual Corporate DirectorBoard Member Dec 1, 2019
David Tatro Individual Corporate OfficerChief Executive Officer Jul 8, 2019 100%
W-2 Managing EmployeeChief Executive Officer Jul 8, 2019 100%
Paul Keech Individual Corporate DirectorBoard Member May 1, 2017
James Preston Individual Corporate OfficerBoard Chairman Jan 1, 2018 100%
Corporate DirectorBoard Member Jan 1, 2018 100%
Kathy Pace Individual Corporate DirectorBoard Member Dec 1, 2018
Mattie Sparks Individual Corporate OfficerBoard 2ND Vice President Nov 11, 2019 100%
Corporate DirectorBoard Member Jan 1, 2018 100%
Donald Branum Individual Corporate DirectorBoard Member May 1, 2017
Jack C. Runner Individual Corporate OfficerBoard 1St Vice President Jan 1, 2020 100%
Corporate DirectorBoard Member Jan 1, 2020 100%
Daniel Moncher Individual Corporate DirectorBoard Member May 1, 2017
Jessica Khaledi Individual Corporate DirectorBoard Member Dec 1, 2019
Edward Widman Individual Corporate DirectorBoard Member Oct 1, 2017
Marietta Johnson Individual Corporate OfficerBoard Secretary Oct 1, 2008
Corporate DirectorBoard Member Oct 1, 2008
Pamela Brumbaugh Individual Corporate DirectorBoard Member May 1, 2017
Kaye Burel Individual Corporate DirectorBoard Member Dec 1, 2018
Nancy McKeen Individual Corporate OfficerBoard Treasurer Oct 1, 2008
Corporate DirectorBoard Member Oct 1, 2008
William Zucker Individual Corporate DirectorBoard Member Oct 1, 2008
Charles Poole Individual Corporate DirectorBoard Member Feb 1, 2017
Marlana Binkley Individual Corporate DirectorAssistant Controller Oct 1, 2017
W-2 Managing EmployeeAssistant Controller Oct 1, 2017 100%
Anthony Pool Individual Corporate DirectorBoard Member Oct 1, 2008

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1695772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695772800000",
    "number": "1508645649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE STE D",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-502-2800",
            "fax_number": "419-502-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 US RTE 20 E",
            "city": "COLLINS",
            "state": "OH",
            "postal_code": "44826",
            "telephone_number": "419-502-2800",
            "fax_number": "419-502-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES OF ERIE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-27",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "TATRO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "419-502-2822"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Collins, OH

Sources for this page

Verify at the official NPI Registry.