NPIMap

Organization Active NPI

Charles Drew Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1639486343
Registry record updated May 10, 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
3720 Florence Blvd
Omaha, NE 68110-1737
Phone
(402) 502-5644
Fax
(402) 502-6436
NPI assigned
Sep 2, 2010
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Authorized official

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Community Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1500X NE
Community Health Clinic/Center 261QC1500X
Community Health Clinic/Center 261QC1500X NE
Federally Qualified Health Center (FQHC) 261QF0400X NE Primary

Addresses

Primary practice location

3720 Florence Blvd
Omaha, NE 68110-1737

Mailing address

PO Box 30019
2915 Grant Street
Omaha, NE 68111-3863
Phone (402) 451-3553

Other identifiers 2

IdentifierTypeStateIssuer
100262314-00OtherNENON-FQHC
100262310-00MedicaidNE

Other names 2

  • Charles Drew Health Center, Inc at King Science Center SBHC Other name
  • Charles Drew Health Center, Inc at King Science and Techonology Magnet School Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120731000357 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

Federally qualified health center certification: CCN 281821

Legal name
CHARLES DREW HEALTH CENTER INC
Doing business as
CHARLES DREW HEALTH CENTER, INC AT KING SCIENCE AND TECHNOLOGY MAGNET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 29, 2012
Last certification
Aug 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1973 in NE
Enrollment address
3720 Florence Blvd
Omaha, NE 68110-1737

Other NPIs with the same Medicare PAC ID 11

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

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
28D2010653King Science Center School Based3720 Florence Boulevard, Omaha, NE 68110Provider-performed microscopyAug 1, 2026

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

Locations

3720 Florence Blvd
Omaha, NE 68110
Phone (402) 502-5644

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 InterestCeo Jan 1, 2016 20%
Corporate DirectorCeo Jan 1, 2016 20%
W-2 Managing EmployeeCeo Jan 1, 2016 20%
Andre Stringfellow Individual 5% Or Greater Direct Ownership Interest Dec 1, 2023

NPI Registry JSON

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

{
    "created_epoch": "1283385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1639486343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30019",
            "address_2": "2915 GRANT STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 FLORENCE BLVD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681101737",
            "telephone_number": "402-502-5644",
            "fax_number": "402-502-6436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER, INC",
        "enumeration_date": "2010-09-02",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON-FQHC",
            "identifier": "100262314-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262310-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Health Center, Inc at King Science Center SBHC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc at King Science and Techonology Magnet School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.