NPIMap

Organization Active NPI

Cincinnati Health Network, Inc

  • Federally Qualified Health Center (FQHC)
  • Cincinnati, OH
National Provider Identifier
1518464635
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CINCINNATI HEALTH NETWORK, INC
Practice address
1615 Republic St
Cincinnati, OH 45202-6464
Phone
(513) 386-7899
NPI assigned
Apr 6, 2018
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Austin Maddox, CPA
Title
Cfo
Phone
(513) 961-0600

Specialties & licenses 1

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

Addresses

Primary practice location

1615 Republic St
Cincinnati, OH 45202-6464

Mailing address

40 E McMicken Ave Ste 3
Cincinnati, OH 45202-6626
Phone (513) 961-0600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180731002351 OH Part A Provider - Federally Qualified Health Center (FQHC) 2062678758 Practice locations: Cincinnati, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1518464635. Details of each certification follow.

Federally qualified health center certification: CCN 361174

Legal name
CINCINNATI HEALTH NETWORK, INC
Doing business as
CENTER FOR RESPITE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 2018
Last certification
Jul 31, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 1986 in OH
Enrollment address
1615 Republic St
Cincinnati, OH 45202-6464

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1044463Center for Respite Care, Inc1615 Republic Street, Cincinnati, OH 45202Certificate of waiverAug 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Cincinnati Health Network I5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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
Mona Jenkins Individual Corporate DirectorBoard Member Oct 1, 2017
Mathew Jackson Individual Corporate DirectorBoard Member Oct 1, 2009
Valorie Costello Individual Corporate DirectorBoard Member Feb 1, 2016
Sandra Driggins-Smith Individual Corporate DirectorBoard Member May 1, 2018
Jerry Bedford Individual Corporate DirectorBoard Vice Chair Oct 1, 2006
Kelly Dunnigan Individual Corporate DirectorBoard Member Jun 1, 2016
Brian Vanderhorst Individual W-2 Managing EmployeeCoo Jan 1, 2016
Toni Winston Individual Corporate DirectorBoard Chair Oct 1, 2014
John Cobey Individual Corporate DirectorBoard Member Feb 1, 2017
Taylor Jenkins Individual Corporate DirectorBoard Member Oct 1, 2014
Kathleen M Wilson Individual Corporate OfficerChief Executive Officer Dec 1, 2003
Operational/Managerial ControlCeo Dec 1, 2003
Ronald Hector Individual Corporate DirectorBoard Member Oct 1, 2010

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cincinnati Health Network, IncCincinnati, OH, CCN 361014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 5, 1986
ShelterhouseCincinnati, OH, CCN 361109 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 5, 1986

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1522972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1518464635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E MCMICKEN AVE STE 3",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452026626",
            "telephone_number": "513-961-0600",
            "fax_number": "513-961-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 REPUBLIC ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452026464",
            "telephone_number": "513-386-7899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCINNATI HEALTH NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-06",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-961-0600",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.