NPIMap

Nevada Health Centers Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Carson City, NV

NPI 1619348489 · NPPES record last updated Oct 19, 2015

Key facts

NPI
1619348489
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
29D2102325 (NV)
Legal business name
NEVADA HEALTH CENTERS INC.
Practice address
618 W. Musser Street
Carson City, NV 89703
Phone
(775) 445-3500
Fax
(775) 461-3251
NPI assigned
Oct 19, 2015
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 24

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

Owned or controlled facilities with NPI records 13

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

Other NPIs on the same Medicare enrollment 34

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

View all 34

Other NPIs with the same Medicare PAC ID 24

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

Facilities with the same owner 13

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

Practitioners 39

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

View all 39

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2102325Nevada Health Centers Carson City School-Based
618 W Musser St, Carson City, NV 89703		Certificate of waiverSep 20, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NV

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
Corporation · Non-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
618 W Musser St
Carson City, NV 89703-4931

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 Director
Board Member		 Aug 1, 2012
Mary L Kieffer
Individual 		Corporate Director
Board Member		 May 15, 2015
Alicia Y Barnes
Individual 		Corporate Director
Board Member		 Aug 1, 2012
Gerald Ackerman
Individual 		Corporate Director
Board Member		 Mar 1, 2011
Linda Bingaman
Individual 		Corporate Director
Board Member		 May 15, 2015
Kathryn L Triplett
Individual 		Corporate Officer
Cfo		 Oct 1, 2016 100%
W-2 Managing Employee
Cfo		 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 Director
Board Member		 May 15, 2015
Jared Carter
Individual 		Corporate Director
Board Member		 Jun 1, 2009
Adriana Fralick
Individual 		Corporate Director
Board Member		 May 15, 2015
Walter B Davis
Individual 		Corporate Officer
Chief Executive Officer		 Nov 26, 2012 100%
W-2 Managing Employee
Chief Executive Officer		 Nov 26, 2012 100%

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

Medicare enrollment records

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

National Provider Directory

Locations

618 W Musser St
Carson City, NV 89703
Phone (775) 445-3500

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
29D2102325OtherNVCLIA

Other names

  • Nevada Health Centers Carson City School Based Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 19, 2015.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "29D2102325",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Health Centers Carson City School Based",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carson City, NV

All providers in Carson City, NV · Federally Qualified Health Center (FQHC) in Nevada

Sources for this page

Verify at the official NPI Registry.