NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as Choptank Mobile Van #1 Medical

  • Federally Qualified Health Center (FQHC)
  • Denton, MD
National Provider Identifier
1609533637
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Doing business as
Choptank Mobile Van #1 Medical
Practice address
808 S 5TH Ave
Denton, MD 21629-1398
Phone
(410) 479-5772
Fax
(410) 479-8397
NPI assigned
Nov 24, 2021
Last updated
Nov 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CHOPTANK COMMUNITY HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

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

Authorized official

Name
Sara Rich
Title
Ceo
Phone
(410) 479-4306

Specialties & licenses 1

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

Addresses

Primary practice location

808 S 5TH Ave
Denton, MD 21629-1398

Mailing address

808 S 5TH Ave
Denton, MD 21629-1398
Phone (410) 479-5772

Other names 1

  • Choptank Mobile Van #1 Medical Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191002002910 MD Part A Provider - Federally Qualified Health Center (FQHC) 0648189274 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denton, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609533637. Details of each certification follow.

Federally qualified health center certification: CCN 211929

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 2019
Last certification
Oct 2, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
808 S 5TH Ave
Denton, MD 21629-1398

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Caroline Health Service103 organizations share this tax ID, including this one
Part of
Caroline Health Service

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 15

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

NameRoleSinceShare
Benjamin Cottle Individual Corporate OfficerCfo Jul 16, 2018
Jennifer W Yost Individual Corporate DirectorBoard Member Feb 1, 2015
Sara K Rich Individual Corporate OfficerCeo Jun 29, 2015
Rebecca Loukides Individual Corporate DirectorBoard Member Aug 1, 2016
Anna Sierra Individual Corporate DirectorBoard Member Jul 21, 2020
Rosemary L Ramsey Individual Corporate DirectorBoard Member May 31, 2022
Savannah S Winston Individual Corporate DirectorBoard Member Jul 12, 2020
Joyneka L Moals Individual Corporate DirectorBoard Member Jul 28, 2022
Sandra O'Neill Individual Corporate DirectorBoard Member May 23, 2019
Wayne Cole Individual Corporate DirectorBoard Member Jul 10, 2020
Matthew R Peters Individual Corporate DirectorBoard Member Apr 1, 2015
Lorenzo L Hughes Individual Corporate DirectorBoard Member Mar 25, 2019
Kimberly R Love Individual W-2 Managing EmployeeFinance Director Feb 22, 2002
Austin N Webster Individual Corporate DirectorBoard Member Jan 23, 2014
Sara B Visintainer Individual Corporate DirectorBoard Member Feb 1, 2015

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637712000000",
    "number": "1609533637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 S 5TH AVE",
            "city": "DENTON",
            "state": "MD",
            "postal_code": "216291398",
            "telephone_number": "410-479-5772",
            "fax_number": "410-479-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 S 5TH AVE",
            "city": "DENTON",
            "state": "MD",
            "postal_code": "216291398",
            "telephone_number": "410-479-5772",
            "fax_number": "410-479-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "enumeration_date": "2021-11-24",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-479-4306"
    },
    "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": "Choptank Mobile Van #1 Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denton, MD

Sources for this page

Verify at the official NPI Registry.