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Organization Active NPI

Charles Drew Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1629530373
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHARLES DREW HEALTH CENTER INC
Practice address
5190 Sprague PLZ Ste 201
Omaha, NE 68104-2891
Phone
(402) 452-3725
Fax
(402) 939-0905
NPI assigned
Apr 2, 2019
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name
Ms. Tarsha Jackson, DO
Title
Chief Financial Officer
Phone
(402) 457-1215

Specialties & licenses 1

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

Addresses

Primary practice location

5190 Sprague PLZ Ste 201
Omaha, NE 68104-2891

Mailing address

5190 Sprague PLZ Ste 201
Omaha, NE 68104-2891
Phone (402) 452-3725

Other names 1

  • Charles Drew Health Center, Inc. at Omaha Home for Boys Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190422000563 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

Federally qualified health center certification: CCN 281849

Legal name
CHARLES DREW HEALTH CENTER INC
Doing business as
CHARLES DREW HEALTH CENTER, INC. AT OMAHA HOME FOR BOYS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 18, 2019
Last certification
Apr 18, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1973 in NE
Enrollment address
5190 Sprague PLZ
Ste 201
Omaha, NE 68104-2886

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Benson Community Health Center19 organizations share this tax ID, including this one
Part of
Benson Community Health Center

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kenny McMorris Individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 20%
Corporate Director Jan 1, 2016 20%
W-2 Managing Employee Jan 1, 2016 20%
Andre Stringfellow Individual 5% Or Greater Direct Ownership Interest Dec 1, 2023 40%

NPI Registry JSON

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1629530373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5190 SPRAGUE PLZ STE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681042891",
            "telephone_number": "402-452-3725",
            "fax_number": "402-939-0905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5190 SPRAGUE PLZ STE 201",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681042891",
            "telephone_number": "402-452-3725",
            "fax_number": "402-939-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER, INC.",
        "enumeration_date": "2019-04-02",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Health Center, Inc. at Omaha Home for Boys",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc. at Omaha Home for Boys",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.