Access Community Health Centers, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Madison, WI
NPI 1669654307 · NPPES record last updated Aug 3, 2016
Key facts
- NPI
- 1669654307
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 37-800 (WI)
- Legal business name
- ACCESS COMMUNITY HEALTH CENTERS, INC.
- Practice address
- 1102 S Park St
Madison, WI 53715-1714 - Phone
- (608) 443-5500
- Fax
- (608) 263-6663
- NPI assigned
- Dec 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Joanne Holland
- Title
- Chief Financial Officer
- Phone
- (608) 443-5518
Owners & managing parties with NPI records 2
-
Kenneth R Loving, MD
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 1
Practitioners 128
-
Karen S Anderson, CNM, APNP
-
Estefan Beltran, MD
-
Kelly Clements, PSYD
-
Mary Kathleen Coleman, MSN, FNP-BC
-
Jessica W Dalby, MD
-
Lee T Dresang, MD
-
Jared Dubey, DO
-
Sean M Duffy, MD
-
Jody C Epstein, MD
-
Kevin E. Fehr, MD
-
Meghan D Fondow, DR
-
Jonathan James Fricke, MD, MPH
-
Joel E Gordon, MD
-
Ashley Grosshans, LCSW
-
Thomas W Hahn, MD
-
Caroline Hensley, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Federally qualified health center certification: CCN 521849
- Legal name
- ACCESS COMMUNITY HEALTH CENTERS INC
- Doing business as
- ACCESS COMMUNITY HEALTH CENTERS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 13, 2013
- Last certification
- Aug 13, 2013
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 19, 1982 in WI
- Enrollment address
- 1102 S Park St
Madison, WI 53715-1708
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Kenneth R Loving |
Corporate Officer |
Feb 26, 2003 | |
| Patricia a Tellez Giron |
Corporate Director |
Jul 1, 2015 | |
| Pratik D. Prajapati |
Corporate Director |
Jul 1, 2015 | |
| Kristina F. Jones |
Corporate Director |
Jul 1, 2015 | |
| Sean J Laborde |
Corporate Director |
Mar 1, 2012 | |
| Eva M Vivian |
Corporate Director |
Jul 1, 2015 | |
| Karen Menendez Collar |
Corporate Director |
Jul 1, 2015 | |
| Richard Donkel |
Corporate Director |
Jul 1, 2015 | |
| Joanne Holland |
Corporate Officer |
Oct 1, 1996 | |
| W-2 Managing Employee |
May 1, 2013 | ||
| Anthony B. Cooper |
Corporate Director |
Jul 1, 2015 | |
| Jack S Bowhan |
Corporate Director |
Jul 1, 2011 | |
| Charlestine Daniel |
Corporate Director |
Jul 1, 2015 | |
| Aleksander Kladnitsky |
Corporate Director |
Jul 1, 2015 | |
| Hamang B Patel |
Corporate Director |
Sep 1, 2012 | |
| Thomas J Hirsch |
Corporate Director |
Jan 1, 2012 | |
| Sean a. Saiz |
Corporate Director |
Jul 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041204000065 | WI | Part B Supplier - Clinic/Group Practice | 0345153672 |
Receives reassigned benefits from 130 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sun Prairie, WI; Madison, WI |
| O20130715000657 | WI | Part a Provider - Federally Qualified Health Center (FQHC) | 0345153672 |
1 other NPI on this enrollment Practice locations: Madison, WI |
National Provider Directory
- Tax ID family
- Access Community Health Centers Inc
Locations
2901 W Beltline Hwy
Ste 120
Madison, WI 53713
Phone (608) 443-5500
2044 S Stoughton Rd
Madison, WI 53716
Phone (608) 271-8009
1270 W Main St
Sun Prairie, WI 53590
Phone (608) 443-5482
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 37-800 | WI | Yes |
Addresses
Primary practice location
1102 S Park St
Madison, WI 53715-1714
Mailing address
2901 W Beltline Hwy
Suite 120
Madison, WI 53713-4226
Phone (608) 443-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32957700 | Medicaid | WI |
Other providers in Madison, WI
- Michael Joseph Accavitti Jr.
- Accelerated Psychiatry, SC
- Access Community Health Centers, Inc.
- Access Community Health Centers, Inc.
- Access Community Health Centers, Inc.
- Access Home Care LLC
- Access to Independence, Inc.
- Accia Community Living LLC
- Ace Dental LLC
- Ace Mentality LLC
All providers in Madison, WI · Federally Qualified Health Center (FQHC) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.