NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bucyrus, OH
National Provider Identifier
1629620109
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC, INC.
Practice address
2458 Stetzer Rd Ste a
Bucyrus, OH 44820-2066
Phone
(419) 522-6191
Fax
(419) 525-6723
NPI assigned
Jul 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

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

Addresses

Primary practice location

2458 Stetzer Rd Ste a
Bucyrus, OH 44820-2066

Mailing address

1404 Park Ave W Ste 2
Ontario, OH 44906-2719
Phone (419) 522-6191

Other names 2

  • Bucyrus Health and Wellness Doing business as
  • Bucyrus Health and Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200128002437 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Bucyrus, OH
O20200520001554 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Bucyrus, OH

Federally qualified health center certification: CCN 721836

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
BUCYRUS HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 27, 2020
Last certification
Jan 27, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 1993 in OH
Enrollment address
2458 Stetzer Rd
Unit a
Bucyrus, OH 44820-2066

Other NPIs with the same Medicare PAC ID 12

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

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
James Dolan Individual Corporate DirectorBoard Member Jan 23, 2018
Dorothy Stratton Individual Corporate DirectorBoard Member Aug 4, 2021
Khushwant Pittenger Individual Corporate DirectorBoard Member Aug 4, 2021
Amber Wertman Individual Corporate DirectorBoard Member Aug 4, 2021
Peggy S Anderson Individual Corporate OfficerCeo Aug 4, 2021
Corporate DirectorBoard Member - P Aug 4, 2021
W-2 Managing EmployeeCeo Aug 4, 2021

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1629620109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W STE 2",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449062719",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2458 STETZER RD STE A",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "448202066",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-15",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "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": "Bucyrus Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bucyrus Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bucyrus Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bucyrus, OH

Sources for this page

Verify at the official NPI Registry.