NPIMap

Organization Active NPI

Collier Health Services, Inc

Doing business as Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
National Provider Identifier
1659864411
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES, INC
Doing business as
Healthcare Network
Practice address
1265 Creekside Pkwy Ste 206
Naples, FL 34108-1954
Phone
(239) 658-3710
Fax
(239) 591-2154
NPI assigned
Jun 7, 2018
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLIER HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Tami Raznoff
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

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

Addresses

Primary practice location

1265 Creekside Pkwy Ste 206
Naples, FL 34108-1954

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other names 1

  • Healthcare Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180924000005 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Naples, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1659864411. Details of each certification follow.

Federally qualified health center certification: CCN 681132

Legal name
COLLIER HEALTH SERVICES, INC
Doing business as
FAMILY CARE NORTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 24, 2018
Last certification
Sep 24, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 17, 1977 in FL
Enrollment address
1265 Creekside Pkwy
Ste 206
Naples, FL 34108-1954

Federally qualified health center certification: CCN 101095

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
CREEKSIDE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 3, 2011
Last certification
Oct 3, 2011
Ownership / control type
For profit – corporation
Facility address
1265 Creekside Pkwy Ste 206
Naples, FL 34108

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Collier Health Services79 organizations share this tax ID, including this one
Part of
Collier Health Services

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jamie Ulmer Individual Corporate OfficerCeo Jan 1, 2024
Haris Domond Individual Corporate Director Apr 17, 2012
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021
Maria Munguia Individual Corporate DirectorBoard Member Jan 1, 2024
John Fletcher Individual Corporate OfficerChief Operating Officer Oct 18, 2021 100%
Tami Raznoff Individual Corporate OfficerCfo May 1, 2019 100%
W-2 Managing EmployeeCfo May 1, 2019 100%
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018
Jean Casnel Paul Individual Corporate Director Nov 27, 2007
Alejandro Castano Individual Corporate DirectorBoard Member Jul 22, 2021
Jerry Starkey Individual Corporate Director Apr 17, 2014
James Douglas Campbell Individual Corporate Director Jun 21, 2011

NPI Registry JSON

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1659864411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 CREEKSIDE PKWY STE 206",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341081954",
            "telephone_number": "239-658-3710",
            "fax_number": "239-591-2154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLIER HEALTH SERVICES, INC",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.