NPIMap

Organization Active NPI

Community Health Center of Lubbock, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lubbock, TX
National Provider Identifier
1528030087
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Practice address
2301 Cedar Ave
Lubbock, TX 79404
Phone
(806) 749-0024
Fax
(806) 749-8806
NPI assigned
Feb 7, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Michael P. Sullivan, CPA
Title
Chief Executive Officer
Phone
(806) 765-2611

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 11

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

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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
45D1030689Chatman Community Health Center2301 Cedar Avenue, Lubbock, TX 79404Provider-performed microscopySep 12, 2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Federally qualified health center certification: CCN 451976

Medicare enrollment files
Legal name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Doing business as
CHATMAN COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 9, 2004
Last certification
Sep 9, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1992 in TX
Enrollment address
2301 Cedar Ave
Lubbock, TX 79404-1629

All disclosed owners & managing parties 12

Medicare enrollment files

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

NameRoleSinceShare
Michael P Sullivan Individual Corporate OfficerChief Executive Officer Jul 1, 1998 100%
W-2 Managing Employee Aug 24, 2004
D. Melynn Henry Individual Corporate DirectorBoard of Director Mar 15, 2016 100%
Brandon Hartley Individual Corporate DirectorBoard of Directors Mar 15, 2016 100%
Aaron S. Davis Individual Corporate DirectorBoard Member May 21, 2019 100%
Elizabeth Lopez Individual W-2 Managing EmployeeChief Dev Officer Apr 9, 2013
James a Johnson Individual Corporate DirectorBoard President Dec 21, 2010 100%
Bertha Martinez Individual Corporate DirectorBoard Member Feb 15, 2005
Barbra C Moore Individual Corporate DirectorFinance Director Dec 22, 2015
W-2 Managing EmployeeFinance Director Dec 22, 2015
Margaret J Gaines Individual Corporate DirectorBoard Member Dec 16, 2008
Patricia a Mora Individual Corporate DirectorBoard Member Aug 19, 2003
Allan C Camacho Individual Corporate DirectorMedical Director Mar 1, 2017
W-2 Managing EmployeeProvider Jul 28, 2012
Gilbert Michael Godinez Individual Corporate DirectorBoard Member May 18, 2021 100%

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040907001328 TX Part a Provider - Federally Qualified Health Center (FQHC) 6002710860 Practice locations: Lubbock, TX
O20180731002269 TX Part B Supplier - Clinic/Group Practice 6002710860 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lubbock, TX

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center (12 organizations share this tax ID)

Locations

2301 Cedar Ave
Lubbock, TX 79404
Phone (806) 749-0024

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

2301 Cedar Ave
Lubbock, TX 79404

Mailing address

1610 5TH St
Lubbock, TX 79401-2622
Phone (806) 765-2611

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
0190217-11MedicaidTX

Other names 1

NPPES NPI Registry
  • Chatman Community Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 7, 2022.

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1528030087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 5TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794012622",
            "telephone_number": "806-765-2611",
            "fax_number": "806-687-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 CEDAR AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79404",
            "telephone_number": "806-749-0024",
            "fax_number": "806-749-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF LUBBOCK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "806-765-2611",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0190217-11",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chatman Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chatman Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.