NPIMap

Organization Active NPI

Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
National Provider Identifier
1669445946
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0073 Issued in CT
Legal business name
OPTIMUS HEALTH CARE INC
Practice address
471 Barnum Ave
Bridgeport, CT 06608-2409
Phone
(203) 576-3885
Fax
(203) 683-3620
NPI assigned
Feb 8, 2006
Last updated
Apr 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Ludwig Spinelli
Title
Chief Executive Officer
Phone
(203) 696-3260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0073 CT Primary

Addresses

Primary practice location

471 Barnum Ave
Bridgeport, CT 06608-2409

Mailing address

982 E Main St
Bridgeport, CT 06608-1913
Phone (203) 696-3260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20031105000254 CT Part B Supplier - Clinic/Group Practice 9335051580 Receives reassigned benefits from 149 practitioners
6 other NPIs on this enrollment
Practice locations: Stamford, CT; Stratford, CT; Milford, CT; Bridgeport, CT
O20080211000766 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Stamford, CT
O20080214000244 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 1 other NPI on this enrollment
Practice locations: Bridgeport, CT
O20080214000293 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Bridgeport, CT
O20080304000508 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Stratford, CT
O20080304000732 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 1 other NPI on this enrollment
Practice locations: Stamford, CT
O20110928000645 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Bridgeport, CT
O20110929000015 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Bridgeport, CT
O20120802000008 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
Practice locations: Stamford, CT

NPI to CCN mapping 8

The Medicare certification numbers (CCNs) connected to NPI 1669445946. Details of each certification follow.

Federally qualified health center certification: CCN 071837

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
STAMFORD COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 7, 2008
Last certification
Mar 7, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
1351 Washington Blvd
Stamford, CT 69022419

Federally qualified health center certification: CCN 071800

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
LUDWIG M. SPINELLI BUILDING
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
471 Barnum Ave
Bridgeport, CT 66082409

Federally qualified health center certification: CCN 071810

Legal name
OPTIMUS HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 18, 1995
Last certification
Dec 18, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
982 E Main St
Bridgeport, CT 66081913

Federally qualified health center certification: CCN 071811

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
STRATFORD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 18, 1995
Last certification
Dec 18, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
305 Boston Ave
Stratford, CT 66145246

Federally qualified health center certification: CCN 071822

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
STAMFORD COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 12, 2000
Last certification
Oct 12, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
805 Atlantic St
Stamford, CT 69026805

Federally qualified health center certification: CCN 071885

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
OPTIMUS WELLNESS CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 2012
Last certification
Jan 17, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
975 E Main St
Bridgeport, CT 66081914

Federally qualified health center certification: CCN 071880

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
PARK CITY PRIMARY CARE CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2011
Last certification
Dec 5, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
64 Black Rock Ave
Bridgeport, CT 66051200

Federally qualified health center certification: CCN 071891

Legal name
OPTIMUS HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 21, 2012
Last certification
Sep 21, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
597 Pacific St
Stamford, CT 69025814

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations

1071 E Main St
Bridgeport, CT 06608
Phone (203) 330-2783

3180 Main St
Ste G1
Bridgeport, CT 06606
Phone (203) 371-7111

3715 Main St
Ste 200
Bridgeport, CT 06606
Phone (203) 372-4065

3715 Main St
Ste 202
Bridgeport, CT 06606
Phone (203) 372-4636

790 Central Ave
Bridgeport, CT 06607
Phone (203) 332-4567

82 George St
#88
Bridgeport, CT 06604
Phone (203) 576-3881

975 E Main St
Bridgeport, CT 06608
Phone (203) 371-7111

949 Bridgeport Ave
Milford, CT 06460
Phone (203) 301-2308

138 Stillwater Ave
Stamford, CT 06902
Phone (203) 357-0277

245 Selleck St
Stamford, CT 06902
Phone (203) 327-5111

597 Pacific St
Stamford, CT 06902
Phone (203) 348-2792

805 Atlantic St
Stamford, CT 06902
Phone (203) 327-5111

305 Boston Ave
Ste 209
Stratford, CT 06614

727 Honeyspot Rd
Stratford, CT 06615
Phone (203) 375-7242

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Colleen Ebankks-Shippey Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate DirectorBoard Member Apr 10, 2017
Bertcelis Morales Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate DirectorBoard Member Apr 10, 2017
Henry H Yoon Individual Corporate DirectorBoard Memebr Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
Karen a Daley Individual Corporate DirectorCeo Jan 1, 2022
W-2 Managing EmployeeCeo Aug 1, 2021
W-2 Managing EmployeeCeo Jan 1, 2022
Corporate DirectorInterim Ceo Aug 1, 2021
W-2 Managing EmployeeInterim Ceo Aug 1, 2021
Carlos de la Iglesia Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate DirectorBoard Member Apr 10, 2017
Mack H Allen Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate DirectorBoard Member Apr 10, 2017
Mavina F Moore Individual Corporate Director Mar 26, 2013
Edgar Rodriguez Individual Corporate Director May 1, 2009
Lydia Martinez Individual Corporate DirectorBoard Member Apr 10, 2017
Julio I Carballo Individual Corporate DirectorBoard Member Oct 1, 2015
Cynthia Morales-Carr Individual Corporate Director May 22, 2010
Colette Toni Individual Corporate DirectorBoard Member Apr 10, 2017
Mayra Cabanas Individual Corporate DirectorBoard Member Apr 10, 2017
Gejuan R Williams Individual Corporate DirectorBoard Member Aug 12, 2015
Timothy Bishop Individual Corporate Director Nov 1, 2003
Katherine a Golar Individual Corporate DirectorCmo Mar 1, 2021
W-2 Managing EmployeeCmo Mar 1, 2021

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 183

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 183

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1669445946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "203-696-3260",
            "fax_number": "203-683-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 BARNUM AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066082409",
            "telephone_number": "203-576-3885",
            "fax_number": "203-683-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUS HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "SPINELLI",
        "authorized_official_first_name": "LUDWIG",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-696-3260"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.