NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as Tilghman Health Center

  • Federally Qualified Health Center (FQHC)
  • Tilghman, MD
National Provider Identifier
1669985032
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Doing business as
Tilghman Health Center
Practice address
21374 Foster Ave
Tilghman, MD 21671-1230
Phone
(410) 886-2222
Fax
(833) 908-2288
NPI assigned
Nov 8, 2017
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Tilghman Health Center Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669985032. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
21374 Foster Ave
Tilghman, MD 21671-1230

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Choptank Community Heal103 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

21374 Foster Ave
Tilghman, MD 21671
Phone (303) 384-0248

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

Owners & managing parties with NPI records 1

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": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1669985032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21374 FOSTER AVE",
            "city": "TILGHMAN",
            "state": "MD",
            "postal_code": "216711230",
            "telephone_number": "108-862-2224",
            "fax_number": "339-082-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21374 FOSTER AVE",
            "city": "TILGHMAN",
            "state": "MD",
            "postal_code": "216711230",
            "telephone_number": "410-886-2222",
            "fax_number": "833-908-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-479-4306"
    },
    "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": "Tilghman Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tilghman, MD

Sources for this page

Verify at the official NPI Registry.