NPIMap

Organization Active NPI

Central Florida Health Care, Inc.

Doing business as Central Florida Health Care- Lakeland Hills Dental

  • Federally Qualified Health Center (FQHC)
  • Lakeland, FL
National Provider Identifier
1568095065
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRAL FLORIDA HEALTH CARE, INC.
Doing business as
Central Florida Health Care- Lakeland Hills Dental
Practice address
1417 Lakeland Hills Blvd Ste 101
Lakeland, FL 33805-3200
Phone
(863) 229-7970
NPI assigned
Feb 13, 2020
Last updated
Jun 10, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRAL FLORIDA HEALTH CARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Ann Claussen
Title
Ceo
Phone
(863) 291-5110

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1417 Lakeland Hills Blvd Ste 101
Lakeland, FL 33805-3200

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (863) 291-5110

Other names 1

  • Central Florida Health Care- Lakeland Hills Dental Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200608002604 FL Part A Provider - Federally Qualified Health Center (FQHC) 0143127951 Practice locations: Lakeland, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568095065. Details of each certification follow.

Federally qualified health center certification: CCN 681178

Legal name
CENTRAL FLORIDA HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 8, 2020
Last certification
Jun 8, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 5, 1953 in FL
Enrollment address
1417 Lakeland Hills Blvd
Ste 101
Lakeland, FL 33805-3200

Other NPIs with the same Medicare PAC ID 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Central Florida Health Care Inc87 organizations share this tax ID, including this one
Part of
Central Florida Health Care Inc

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Central Florida Health Care Inc Organization, Winter Haven, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 11, 2020
Jennings Brinson Individual Corporate DirectorBoard of Directors- Vice Chairman Aug 11, 2017
Tina Solomon Individual Corporate OfficerChief Financial Officer Apr 15, 2019
W-2 Managing EmployeeChief Financial Officer Apr 15, 2019
Operational/Managerial ControlChief Financial Officer Apr 15, 2019
Cara Roseanne Nelson-James Individual Contracted Managing EmployeeChief Medical Officer Dec 1, 2019
Corporate OfficerChief Medical Officer Dec 1, 2019
Nicholas a Emanuel Individual Corporate DirectorBoard of Directors- Chairman May 27, 2008
Beth Luxford Individual Corporate DirectorBoard of Directors Co-Chair Jan 27, 2020
Ann M Claussen Individual Corporate OfficerChief Executive Officer Jan 1, 2014
W-2 Managing EmployeeChief Executive Officer Jan 1, 2014
Operational/Managerial ControlChief Executive Officer Jan 1, 2014
Karen McKenzie Individual Corporate OfficerChief Dental Officer Jan 8, 2021
Lawrence Best Individual Corporate OfficerChief Operating Officer Jul 25, 2017
Operational/Managerial ControlChief Operating Officer Jul 25, 2017
Andrew N Hein Individual Corporate OfficerChief Clinical Informatics Officer Jul 1, 2012
Operational/Managerial ControlChief Clinical Informatics Officer Jul 1, 2012
Barbara Turner Individual Corporate OfficerChief Quality Officer May 5, 2014
Operational/Managerial ControlChief Quality Officer May 5, 2014
Nasseam McPherson James Individual Corporate Director Jun 21, 2016
Philip Kenney Individual Contracted Managing EmployeeChief Human Resources Officer Jan 11, 2016
Corporate OfficerChief Human Resources Officer Jan 11, 2016

Owners & managing parties with NPI records 20

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

View all 20

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Central Florida Health Care, Inc.-FrostproofFrostproof, FL, CCN 101851 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1994
Central Florida Health Care IncWinter Haven, FL, CCN 681068 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 30, 2016
Central Florida Health Care IncDundee, FL, CCN 681065 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 2020
Central Florida Health Care IncLake Wales, FL, CCN 681066 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 1, 2016
Central Florida Health Care IncDavenport, FL, CCN 691010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Central Florida Health Care IncBartow, FL, CCN C11021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 2, 2024

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 6

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": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1568095065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "863-291-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 LAKELAND HILLS BLVD STE 101",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338053200",
            "telephone_number": "863-229-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA HEALTH CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL FLORIDA HEALTH CARE, INC.",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "CLAUSSEN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "863-291-5110"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Florida Health Care- Lakeland Hills Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Florida Health Care- Lakeland Hills Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

Verify at the official NPI Registry.