NPIMap

Organization Active NPI

Detroit Community Health Connection, Inc

Doing business as Dr. Peter Slaughter Health Center

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1588137376
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION, INC
Doing business as
Dr. Peter Slaughter Health Center
Practice address
20303 Kelly Rd
Detroit, MI 48225-1206
Phone
(313) 347-2116
Fax
(313) 245-7009
NPI assigned
Jan 4, 2019
Last updated
Jan 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Authorized official

Name
Mahipal Rao Kakarala
Title
Sr VP & Cfo
Phone
(313) 821-2591

Specialties & licenses 1

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

Addresses

Primary practice location

20303 Kelly Rd
Detroit, MI 48225-1206

Mailing address

13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone (313) 821-2591

Other names 1

  • Dr. Peter Slaughter Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000067 MI Part B Supplier - Clinic/Group Practice 9234021148 Receives reassigned benefits from 23 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI
O20190218001615 MI Part A Provider - Federally Qualified Health Center (FQHC) 9234021148 Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588137376. Details of each certification follow.

Federally qualified health center certification: CCN 231139

Legal name
DETROIT COMMUNITY HEALTH CONNECTION INC
Doing business as
DR PETER SLAUGHTER HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2019
Last certification
Feb 5, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
20303 Kelly Rd
Detroit, MI 48225-1206

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Detroit Community Health Connection9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

20303 Kelly Rd
Harper Woods, MI 48225
Phone (313) 245-7000

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Patrick O Lindsey Individual Corporate DirectorBoard Secretary Oct 27, 2015
Hallistine Stewart Individual Corporate Director Oct 27, 2015
Derek Ware Individual Corporate OfficerPresident & Ceo Sep 13, 2024
Crystal R Gardner-Martin Individual Corporate Director May 17, 2024
Henry Tokarz Individual Corporate DirectorVice President & Cfo Mar 3, 2025
Henry C Conerway Individual Corporate DirectorVice Chairperson Jul 27, 2021
Linda J Bowie Individual Corporate Director Jul 27, 2021
Mable Jones Individual Corporate Director Feb 27, 2025
Patricia a Wilkerson-Uddyback Individual W-2 Managing EmployeeChief Medical Officer Feb 26, 2024
Gwendolyn J Scales Individual Corporate Director Nov 1, 2009
Thomas E Hardiman Individual Corporate Director Jul 27, 2021
Louise Guyton Individual Corporate DirectorBoard Treasurer Jan 1, 2003
Paul Bridgewater Individual Corporate DirectorBoard Chairperson Sep 1, 2007
Eric B Scott Individual Corporate Director Dec 1, 2024
Vanessa Holsey Individual Corporate Director Sep 1, 2024
Detroit Community Health Connection Inc Organization, Detroit, MI Operational/Managerial Control Dec 12, 2018
Gregory a Jones Individual Corporate Director Dec 27, 2015

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Dr Sophie Womack Health CenterDetroit, MI, CCN 231937 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Woodward Corridor Family Medical CenterDetroit, MI, CCN 231936 Federally qualified health center Operational/Managerial Control (100%) Apr 18, 1997
Dr Feleta Wilson Health CenterDetroit, MI, CCN 231935 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Nolan Family Health CenterDetroit, MI, CCN 231934 Federally qualified health center Operational/Managerial Control Feb 11, 2004
Oscar Paskal Health CenterDetroit, MI, CCN 231015 Federally qualified health center Operational/Managerial Control Aug 11, 2011

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1588137376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-821-2591",
            "fax_number": "313-822-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20303 KELLY RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482251206",
            "telephone_number": "313-347-2116",
            "fax_number": "313-245-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "KAKARALA",
        "authorized_official_first_name": "MAHIPAL",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "SR VP & CFO",
        "authorized_official_telephone_number": "313-821-2591"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Peter Slaughter Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.