NPIMap

Organization Active NPI

Peak Vista Community Health Centers

Doing business as Family Health Center at Mitchell High School

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
National Provider Identifier
1639714041
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
Family Health Center at Mitchell High School
Practice address
4041 E San Miguel St
Colorado Springs, CO 80909
Phone
(719) 632-5700
NPI assigned
Nov 8, 2019
Last updated
Mar 6, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEAK VISTA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Authorized official

Name
Ryan Spillane
Title
Chief Financial Officer
Phone
(719) 344-7135

Specialties & licenses 1

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

Addresses

Primary practice location

4041 E San Miguel St
Colorado Springs, CO 80909

Mailing address

3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917-5152
Phone (719) 344-6873

Other identifiers 1

IdentifierTypeStateIssuer
05638267MedicaidCO

Other names 1

  • Family Health Center at Mitchell High School Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191206002079 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 Practice locations: Colorado Springs, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639714041. Details of each certification follow.

Federally qualified health center certification: CCN 061007

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
FAMILY HEALTH CENTER AT MITCHEL HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2019
Last certification
Dec 6, 2019
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Oct 31, 2019 in CO
Enrollment address
4041 E San Miguel St
Colorado Springs, CO 80909-6908

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center27 organizations share this tax ID, including this one
Part of
Community Health Center

Other organizations with this tax ID 26

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

View all 26

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
William C Sanden Individual OtherBoard Member Jan 1, 2019
Ray Nunn Individual Corporate DirectorBoard Member Oct 1, 2019
Ryan Spillane Individual Corporate OfficerChief Financial Officer Sep 26, 2022
Dennis Smialek Individual Corporate DirectorBoard Member Mar 3, 2020
Santiago R Duran Individual OtherBoard Member Sep 6, 2017
John Eastman Individual OtherBoard Member Jan 18, 2024
Gertrud M Horvath Individual OtherBoard Member Feb 7, 2017
Erica Oakley-Courage Individual OtherBoard Member Mar 1, 2016
Rocio Rodriguez Individual OtherBoard Member Sep 1, 2023
Mary M Sheetz Individual OtherBoard Member Jan 9, 2018
Leila P Gibson-Green Individual OtherBoard Member Dec 1, 2022
Fadi Youkhana Individual OtherBoard Member Jun 1, 2023
Stella U Hodgkins Individual OtherBoard Member Nov 1, 2022
Denise Smith Silva Individual W-2 Managing EmployeeBusiness Systems Manager Mar 31, 1987
David Fairley Individual OtherBoard Member Jun 1, 2022

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mobile Health Services VanColorado Springs, CO, CCN 061909 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 15, 2012
Logan Health Center at Myron StrattonColorado Springs, CO, CCN 061914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012
Pediatric Health CenterColorado Springs, CO, CCN 061917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1639714041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD STE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175152",
            "telephone_number": "719-344-6873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 E SAN MIGUEL ST",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80909",
            "telephone_number": "719-632-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2019-11-08",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "719-344-7135"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638267",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Health Center at Mitchell High School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Health Center at Mitchell High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.