NPIMap

Organization Active NPI

Camillus Health Concern, Inc.

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1659536365
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMILLUS HEALTH CONCERN, INC.
Practice address
1907 NW 38TH St Ste 195
Miami, FL 33142-5446
Phone
(305) 637-6720
Fax
(305) 635-1123
NPI assigned
Jul 22, 2008
Last updated
Feb 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Authorized official

Name
Francis Afram-Gyening, FACHE
Title
Chief Executive Officer
Phone
(305) 533-0189

Specialties & licenses 1

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

Addresses

Primary practice location

1907 NW 38TH St Ste 195
Miami, FL 33142-5446

Mailing address

336 NW 5TH St
Miami, FL 33128-1616
Phone (305) 577-4840

Other identifiers 2

IdentifierTypeStateIssuer
680002514MedicaidFL
680002505MedicaidFL

Other names 1

  • Salvation Army Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000614 FL Part B Supplier - Clinic/Group Practice 4688575210 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL
O20230530000219 FL Part A Provider - Federally Qualified Health Center (FQHC) 4688575210 Practice locations: Miami, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1659536365. Details of each certification follow.

Federally qualified health center certification: CCN 691058

Legal name
CAMILLUS HEALTH CONCERN INC
Doing business as
SALVATION ARMY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 30, 2023
Last certification
May 30, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1988 in FL
Enrollment address
1907 NW 38TH St
Ste 195
Miami, FL 33142-5446

Federally qualified health center certification: CCN 101827

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SALAVATION ARMY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2008
Last certification
Nov 19, 2008
Ownership / control type
For profit – corporation
Facility address
1907 NW 38TH Street
Miami, FL 33142

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

1603 NW 7th Ave
Miami, FL 33136
Phone (305) 374-1065

1907 NW 38th St
Miami, FL 33142
Phone (305) 573-4200

1907 NW 38th St
Ste 195
Miami, FL 33142
Phone (305) 637-6720

724 NW 17th St
Miami, FL 33136
Phone (305) 326-0032

726 NE 1st Ave
Miami, FL 33132
Phone (305) 374-1065

800 NW 28th St
Miami, FL 33127
Phone (305) 634-3409

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jacki Quinonez Individual Corporate DirectorBoard of Directors Jan 1, 2021
Kenneth Okeefe Individual Corporate DirectorBoard of Directors Jan 24, 2018
Richard Macphee Individual Corporate DirectorBoard of Directors Jan 24, 2011
Evan Piper Individual Corporate DirectorBoard of Directors Mar 22, 2013
Sandra Sears Individual Corporate DirectorBoard of Directors Sep 17, 2017
Reggie Lewis Individual Corporate DirectorBoard of Directors Dec 31, 2019
John Dubois Individual Corporate DirectorBoard of Directors Aug 26, 2009
Francis Afram-Gyening Individual Corporate DirectorCeo May 15, 2017
W-2 Managing EmployeeCeo May 15, 2017 100%
Vicente Vazquez Individual Corporate DirectorBoard of Directors Jan 31, 2019
Camillus Health Concern Inc Organization, Miami, FL Corporation, For-profit Operational/Managerial Control Aug 13, 2022 100%
Charles Magoffin Individual Corporate DirectorBoard of Directors Jun 14, 2017
Mary H Hayden Individual Corporate DirectorBoard of Directors Aug 26, 2009
McKenley Romeo Individual Corporate DirectorBoard of Directors Jan 1, 2014
Marie Dezelick Individual Corporate DirectorBoard of Directors Sep 23, 2016
Bryan Person Individual Corporate DirectorBoard of Directors Jun 14, 2017
Vincent Vento Individual Corporate DirectorBoard of Directors Jul 29, 2011
David V. Peery Individual Corporate DirectorBoard of Directors Jan 1, 2021
Thomas Abraham Individual Corporate DirectorBoard of Directors Jul 20, 2011
Ana Viamonte Ros Individual Corporate DirectorBoard of Directors Mar 18, 2011

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1659536365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 NW 5TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331281616",
            "telephone_number": "305-577-4840",
            "fax_number": "305-373-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 NW 38TH ST STE 195",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331425446",
            "telephone_number": "305-637-6720",
            "fax_number": "305-635-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILLUS HEALTH CONCERN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "AFRAM-GYENING",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "305-533-0189",
        "authorized_official_credential": "FACHE"
    },
    "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": "680002514",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "680002505",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salvation Army",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Salvation Army",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.