NPIMap

Organization Active NPI

Neighborhood Health Care Incorporated

Doing business as Neighborhood Family Practice

  • Federally Qualified Health Center (FQHC)
  • Lakewood, OH
National Provider Identifier
1669146908
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD HEALTH CARE INCORPORATED
Doing business as
Neighborhood Family Practice
Practice address
14306 Detroit Ave RM a
Lakewood, OH 44107-4417
Phone
(216) 281-0872
Fax
(216) 961-5429
NPI assigned
Aug 2, 2021
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Christine D Porter
Title
Cfo
Phone
(216) 281-8945

Specialties & licenses 1

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

Addresses

Primary practice location

14306 Detroit Ave RM a
Lakewood, OH 44107-4417

Mailing address

4115 Bridge Ave Ste 300
Cleveland, OH 44113-3304
Phone (216) 281-0872

Other names 1

  • NEIGHBORHOOD FAMILY PRACTICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220205000094 OH Part A Provider - Federally Qualified Health Center (FQHC) 2668466012 Practice locations: Lakewood, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669146908. Details of each certification follow.

Federally qualified health center certification: CCN 721947

Legal name
NEIGHBORHOOD HEALTH CARE INCORPORATED
Doing business as
NEIGHBORHOOD FAMILY PRACTICE
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 1979 in OH
Enrollment address
14306 Detroit Ave
RM a
Lakewood, OH 44107-4417

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Neighborhood Health Car20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Victor Cruz Individual Corporate DirectorBoard Member Jan 1, 2021
Monica Olivera Individual Corporate DirectorBoard Member Jan 29, 2019
Jean Polster Individual Corporate OfficerCeo Feb 24, 2003
W-2 Managing EmployeeCeo Feb 24, 2003
Natalie Adsuar Individual Corporate DirectorBoard Member Jan 1, 2021
Fred Degrandis Individual Corporate DirectorBoard Member Jan 1, 2019
John Griffiths Individual Corporate DirectorVice Chair Jan 1, 2019
Mark McDermott Individual Corporate DirectorBoard Member Jul 1, 2017
Samuel Huston Individual Corporate DirectorBoard Member Jan 14, 2013
Lisa Nelson Individual Corporate DirectorBoard Member Mar 1, 2016
Alan Mancuso Individual Corporate DirectorBoard Member Jan 1, 2012
Jonathan Sieck Individual Corporate DirectorSecretary Nov 24, 2019
Tyler Allchin Individual Corporate DirectorBoard Member Feb 1, 2018
Anita Cook Individual Corporate DirectorBoard Member Jan 4, 2013
Steve Ansberry Individual Corporate DirectorBoard Treasurer Sep 1, 2018
Christine Porter Individual Corporate OfficerChief Financial Officer May 16, 2015
Morgan Taggert Individual Corporate DirectorBoard Chair Sep 1, 2019
Ala N Qahwash Individual Corporate DirectorBoard Member Aug 1, 2021
Sonya Caswell Individual Corporate DirectorBoard Member Jul 1, 2017
Jonathon Wise Individual Corporate DirectorBoard Member Jan 27, 2014
Matthew Garvey Individual Corporate DirectorBoard Member Feb 1, 2009
Jean Solomon Individual Corporate DirectorBoard Member Nov 1, 2012
Dennis Duck Individual Corporate DirectorBoard Member Jan 1, 2012
Erick R Kauffman Individual Corporate OfficerChief Medical Officer Jul 1, 2014
W-2 Managing EmployeeChief Medical Officer Jul 1, 2014
Daphney McCaleb Individual Corporate DirectorBoard Member Jul 1, 2021
Chris Warren Individual Corporate DirectorBoard Member Oct 1, 2016

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1669146908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4115 BRIDGE AVE STE 300",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441133304",
            "telephone_number": "216-281-0872",
            "fax_number": "216-961-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14306 DETROIT AVE RM A",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074417",
            "telephone_number": "216-281-0872",
            "fax_number": "216-961-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD HEALTH CARE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "216-281-8945"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEIGHBORHOOD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NEIGHBORHOOD FAMILY PRACTICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, OH

Sources for this page

Verify at the official NPI Registry.