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Choptank Community Health System Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Tilghman, MD

NPI 1669985032 · NPPES record last updated Oct 30, 2020

Key facts

NPI
1669985032
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Practice address
21374 Foster Ave
Tilghman, MD 21671-1230
Phone
(410) 886-2222
Fax
(833) 908-2288
NPI assigned
Nov 8, 2017
Organization subpart
No

Authorized official

Name
Sara Rich
Title
Ceo
Phone
(410) 479-4306

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 24

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

Practitioners 40

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

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

Federally qualified health center certification: CCN 211919

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2017
Last certification
Dec 1, 2017
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
21374 Foster Ave
Tilghman, MD 21671-1230

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
Benjamin Cottle
Individual 		Corporate Officer
Cfo		 Jul 16, 2018
Jennifer W Yost
Individual 		Corporate Director
Board Member		 Feb 1, 2015
Sara K Rich
Individual 		Corporate Officer
Ceo		 Jan 1, 2017
Rebecca Loukides
Individual 		Corporate Director
Board Member		 Aug 1, 2016
Carlene L Wilson
Individual 		Corporate Director
Board Member		 Sep 1, 2022
Anna Sierra
Individual 		Corporate Director
Board Member		 Feb 28, 2020
Rosemary L Ramsey
Individual 		Corporate Director
Board Member		 May 31, 2022
Savannah S Winston
Individual 		Corporate Director
Board Member		 Feb 28, 2020
Joyneka L Moals
Individual 		Corporate Director
Board Member		 Jul 28, 2022
Sandra O'Neill
Individual 		Corporate Director
Board Member		 May 23, 2019
Wayne Cole
Individual 		Corporate Director
Board Member		 Jan 31, 2020
Matthew R Peters
Individual 		Corporate Director
Board Member		 Apr 1, 2015
Lorenzo L Hughes
Individual 		Corporate Director
Board Member		 Mar 25, 2019
Kimberly R Love
Individual 		W-2 Managing Employee
Finance Director		 Feb 19, 2002
Austin N Webster
Individual 		Corporate Director
Board Member		 Jan 1, 2009
Sara B Visintainer
Individual 		Corporate Director
Board Member		 Feb 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20171201000194 MD Part a Provider - Federally Qualified Health Center (FQHC) 0648189274 Practice locations: Tilghman, MD

National Provider Directory

Tax ID family
Choptank Community Health System Inc (103 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

21374 Foster Ave
Tilghman, MD 21671-1230

Mailing address

21374 Foster Ave
Tilghman, MD 21671-1230
Phone (108) 862-2224

Other names

  • Tilghman Health Center Doing business as

Other providers in Tilghman, MD

All providers in Tilghman, MD · Federally Qualified Health Center (FQHC) in Maryland

Sources for this page

Verify at the official NPI Registry.