NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
National Provider Identifier
1649599119
Registry record updated Jun 3, 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
770 Balgreen Drive
Suite 207
Mansfield, OH 44906-2633
Phone
(419) 522-6800
Fax
(419) 522-6816
NPI assigned
May 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

770 Balgreen Drive
Suite 207
Mansfield, OH 44906-2633

Mailing address

1404 Park Ave W
Ste 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other identifiers 1

IdentifierTypeStateIssuer
3111957MedicaidOH

Other names 2

  • Cornerstone OB/GYN Doing business as
  • Third Street OB/GYN Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000770 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
Practice locations: Ashland, OH; Mansfield, OH; Ontario, OH
O20100810000138 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Mansfield, OH

Federally qualified health center certification: CCN 361960

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
CORNERSTONE OB/GYN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2010
Last certification
Aug 12, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
770 Balgreen Dr
Ste 207
Mansfield, OH 44906-4106
Related CCNs
361877

Facilities connected through Provider of Services related, parent or unit certification numbers.

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 2

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

National Provider Directory

National Provider Directory

Locations

2131 Park Ave W
Ste 200
Ontario, OH 44906
Phone (419) 525-6730

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate OfficerCfo Jan 28, 2013
W-2 Managing EmployeeCfo Jan 28, 2013
James Dolan Individual Corporate DirectorBoard Member Jul 27, 2021
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 27, 2021
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Joe Stafford Individual Corporate DirectorBoard Member Oct 19, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Cindy Wetterau Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 27, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Tom Walker Individual Corporate DirectorBoard Member Oct 19, 2023
Amber Wertman Individual Corporate DirectorBoard Member Jul 27, 2021
Cody Albert Individual Corporate DirectorBoard Member Jul 27, 2021
Peggy S Anderson Individual Corporate DirectorCeo Jul 27, 2021
W-2 Managing EmployeeCeo Jul 27, 2021
Joe Devany Individual Corporate DirectorBoard Member Oct 19, 2023
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Jul 27, 2021
W-2 Managing EmployeeCoo Jul 27, 2021
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1274659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780444800000",
    "number": "1649599119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "STE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-522-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 BALGREEN DRIVE",
            "address_2": "SUITE 207",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6800",
            "fax_number": "419-522-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-24",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "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": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "3111957",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cornerstone OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third Street OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Third Street OB/GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.