NPIMap

Organization Active NPI

Suncoast Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Brandon, FL
National Provider Identifier
1669830832
Registry record updated Mar 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNCOAST COMMUNITY HEALTH CENTERS, INC
Practice address
313 South Lakewood Drive
Brandon, FL 33511
Phone
(813) 349-7900
NPI assigned
Feb 3, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2016

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

Authorized official

Name
Robert R Rodriguez
Title
Cfo
Phone
(813) 349-7563

Specialties & licenses 1

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

Addresses

Primary practice location

313 South Lakewood Drive
Brandon, FL 33511

Mailing address

13110 Elk Mountain Dr
Riverview, FL 33579-7182
Phone (813) 349-7567

Other names 1

  • Brandon Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140806000102 FL Part A Provider - Federally Qualified Health Center (FQHC) 3870402548 1 other NPI on this enrollment
Practice locations: Brandon, FL

Federally qualified health center certification: CCN 101169

Legal name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Doing business as
BRANDON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2014
Last certification
Aug 6, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 1977 in FL
Enrollment address
313 South Lakewood Dr
Brandon, FL 33511-2815

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Suncoast Community Health Centers Inc26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

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

View all 25

Locations

1729 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 686-0082

Networks

  • HealthSun Health Plans Network
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Roberto Morales Individual Corporate OfficerCoo Jan 1, 2022
W-2 Managing EmployeeCoo Jan 1, 2022
Operational/Managerial ControlCoo Jan 1, 2022
Gwendolyn Smalley Individual Corporate DirectorBoard Member Sep 8, 2010
Bradley Herremans Individual Corporate OfficerCeo Sep 8, 2010
W-2 Managing EmployeeCeo Sep 8, 2010
Operational/Managerial ControlCeo Sep 8, 2010
Dina M Bastian Individual W-2 Managing EmployeeBilling Manager Feb 20, 1995
Nancy Hewlett Individual Corporate DirectorBoard Member Jan 1, 2022
Brian Shaub Individual Corporate OfficerChief Medical Director Jan 1, 2022
W-2 Managing EmployeeChief Medical Director Jan 1, 2022
Operational/Managerial ControlChief Medical Director Jan 1, 2022
Carlos Garcia Individual Corporate DirectorVice Chair May 21, 2013
Susan Peltz Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial ControlCfo Jan 3, 2025
Elbert Odor Individual Corporate DirectorBoard Member May 23, 2012
Nelson Ramos Individual Corporate DirectorBoard Member Sep 8, 2010
Maria Consuela Huber Individual Corporate DirectorTreasurer Jan 1, 2022
Aura M Cisneros Individual Corporate OfficerChief Dental Officer Jan 1, 2022
W-2 Managing EmployeeChief Dental Officer Jan 1, 2022
Operational/Managerial ControlChief Dental Officer Jan 1, 2022
Krystal Lockhart Individual Corporate DirectorSecretary Jan 1, 2022
Ivon Ruz Individual Corporate DirectorBoard Member Jan 1, 2022
Rich Glorioso Individual Corporate DirectorBoard Member Jan 1, 2022

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 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457395200000",
    "number": "1669830832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 ELK MOUNTAIN DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797182",
            "telephone_number": "813-349-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 SOUTH LAKEWOOD DRIVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "33511",
            "telephone_number": "813-349-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-03",
        "last_updated": "2016-03-08",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "813-349-7563"
    },
    "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": "Brandon Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.