NPIMap

Organization Active NPI

Jessie Trice Community Health System Inc

  • Federally Qualified Health Center (FQHC)
  • Miami Gardens, FL
National Provider Identifier
1639518798
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Practice address
20612 NW 27TH Ave
Miami Gardens, FL 33056-1469
Phone
(305) 637-6400
Fax
(305) 636-5155
NPI assigned
Jun 21, 2013
Last updated
Oct 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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

Authorized official

Name
Ryan R Hawkins
Title
President/Ceo
Phone
(305) 805-1700

Specialties & licenses 1

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

Addresses

Primary practice location

20612 NW 27TH Ave
Miami Gardens, FL 33056-1469

Mailing address

5607 NW 27TH Ave Ste 1
Miami, FL 33142-2826
Phone (305) 805-1700

Other identifiers 1

IdentifierTypeStateIssuer
029541846MedicaidFL

Other names 2

  • Jessie Trice Community Health Center Inc Former legal business name
  • JTCHS Barbara J Jordan Community Health Wellness Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041020000714 FL Part B Supplier - Clinic/Group Practice 2961486733 Receives reassigned benefits from 59 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Opa Locka, FL; Miami Gardens, FL; Hialeah, FL
O20140403000010 FL Part A Provider - Federally Qualified Health Center (FQHC) 2961486733 Practice locations: Miami Gardens, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639518798. Details of each certification follow.

Federally qualified health center certification: CCN 101148

Legal name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 14, 2014
Last certification
Apr 14, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1967 in FL
Enrollment address
20612 NW 27TH Ave
Miami Gardens, FL 33056-1469

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Economic Opportunity FH15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

20612 NW 27th Ave
Ste 1
Miami Gardens, FL 33056

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Ryan Hawkins Individual Corporate DirectorPresident/Ceo Mar 1, 2024
W-2 Managing EmployeeAd; Mar 1, 2024
Irene N Taylor-Wooten Individual Corporate DirectorBoard of Directors Jan 1, 2010
Pedro Gassant Individual Corporate DirectorBoard of Directors Mar 27, 2023
Paul Roberts Individual Corporate DirectorBoard of Directors Jan 1, 2010
Tishria L Mindingall Individual Corporate DirectorBoard of Directors Jan 1, 2010
Lenora Yates Individual Corporate DirectorBoard of Directors Mar 27, 2023
Angela D Lightfoot Individual Corporate DirectorBoard of Directors Jan 1, 2010
Carla Jones Individual Corporate DirectorBoard of Directors Jan 1, 2010
Thamara R Labrousee Individual Corporate DirectorBoard of Directors Jan 1, 2010
Terrell G West Individual Corporate DirectorBoard of Directors Jan 1, 2010
Olga Connor Individual Corporate DirectorBoard of Directors Feb 27, 2023
Sherwood G Dubose Individual Corporate DirectorBoard of Directors Jan 1, 2010
Ivette Klein Individual Corporate DirectorBoard of Directors Mar 27, 2023
David Williams Individual Corporate DirectorBoard of Directors Jan 1, 2010
Robert L Thomas Individual Corporate DirectorBoard of Directors Jan 1, 2010

Practitioners & affiliated clinicians

Practitioners 57

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.

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792627200000",
    "number": "1639518798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 NW 27TH AVE STE 1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331422826",
            "telephone_number": "305-805-1700",
            "fax_number": "305-805-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20612 NW 27TH AVE",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330561469",
            "telephone_number": "305-637-6400",
            "fax_number": "305-636-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-21",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "305-805-1700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029541846",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessie Trice Community Health Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "JTCHS Barbara J Jordan Community Health Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami Gardens, FL

Sources for this page

Verify at the official NPI Registry.