NPIMap

Organization Active NPI

Nevada Health Centers Inc.

Doing business as Nevada Health Centers Carson City School Based

  • Federally Qualified Health Center (FQHC)
  • Carson City, NV
National Provider Identifier
1619348489
Registry record updated Oct 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
29D2102325 Issued in NV
Legal business name
NEVADA HEALTH CENTERS INC.
Doing business as
Nevada Health Centers Carson City School Based
Practice address
618 W. Musser Street
Carson City, NV 89703
Phone
(775) 445-3500
Fax
(775) 461-3251
NPI assigned
Oct 19, 2015
Last updated
Oct 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2015

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

Authorized official

Name
Walter B Davis
Title
Ceo
Phone
(775) 888-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 29D2102325 NV Primary

Addresses

Primary practice location

618 W. Musser Street
Carson City, NV 89703

Mailing address

3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610

Other names 1

  • Nevada Health Centers Carson City School Based Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20160427001966 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Carson City, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619348489. Details of each certification follow.

Federally qualified health center certification: CCN 291854

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
NEVADA HEALTH CENTERS CARSON CITY SCHOOL BASED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2016
Last certification
May 17, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
618 W Musser St
Carson City, NV 89703-4931

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 34

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

View all 34

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
29D2102325Nevada Health Centers Carson City School-Based618 W Musser St, Carson City, NV 89703Certificate of waiverSep 20, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Donald E Chaney Individual Corporate DirectorBoard Member Aug 1, 2012
Mary L Kieffer Individual Corporate DirectorBoard Member May 15, 2015
Alicia Y Barnes Individual Corporate DirectorBoard Member Aug 1, 2012
Gerald Ackerman Individual Corporate DirectorBoard Member Mar 1, 2011
Linda Bingaman Individual Corporate DirectorBoard Member May 15, 2015
Kathryn L Triplett Individual Corporate OfficerCfo Oct 1, 2016 100%
W-2 Managing EmployeeCfo Oct 1, 2016 100%
Nevada Health Centers Inc Organization, Carson City, NV Non-profit 5% Or Greater Direct Ownership Interest Dec 21, 2015 100%
Maurice Washington Individual Corporate DirectorBoard Member May 15, 2015
Jared Carter Individual Corporate DirectorBoard Member Jun 1, 2009
Adriana Fralick Individual Corporate DirectorBoard Member May 15, 2015
Walter B Davis Individual Corporate OfficerChief Executive Officer Nov 26, 2012 100%
W-2 Managing EmployeeChief Executive Officer Nov 26, 2012 100%

Owners & managing parties with NPI records 24

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

View all 24

All facility ownership & control disclosures 13

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Eastern Family Medical and Dental CenterLas Vegas, NV, CCN 291837 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2010
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children's Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Willow Street Health CenterReno, NV, CCN 291009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 22, 2023
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

Owned or controlled facilities with NPI records 13

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

View all 13

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1445212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445212800000",
    "number": "1619348489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 W. MUSSER STREET",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "89703",
            "telephone_number": "775-445-3500",
            "fax_number": "775-461-3251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-19",
        "last_updated": "2015-10-19",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NV",
            "license": "29D2102325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Health Centers Carson City School Based",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carson City, NV

Sources for this page

Verify at the official NPI Registry.