NPIMap

Organization Active NPI

Collier Health Services Inc

Doing business as Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
National Provider Identifier
1679124010
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES INC
Doing business as
Healthcare Network
Practice address
12655 Collier Blvd
Naples, FL 34116-4005
Phone
(239) 658-3000
NPI assigned
Sep 26, 2019
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Tami Raznoff
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

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

Addresses

Primary practice location

12655 Collier Blvd
Naples, FL 34116-4005

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other names 1

  • Healthcare Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200309001778 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Naples, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679124010. Details of each certification follow.

Federally qualified health center certification: CCN 681172

Legal name
COLLIER HEALTH SERVICES, INC
Doing business as
HEALTHCARE NETWORK SW FL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 2020
Last certification
Mar 9, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
12655 Collier Blvd
Naples, FL 34116-4005

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Horizons Primary Care Center79 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

12655 Collier Blvd
Naples, FL 34116
Phone (239) 571-9015

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jamie Ulmer Individual Corporate OfficerCeo Jan 1, 2024
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021
Maria Munguia Individual Corporate DirectorBoard Member Jan 1, 2024
John Fletcher Individual Corporate OfficerChief Operating Officer Oct 18, 2021 100%
Tami Raznoff Individual Corporate OfficerCfo Jan 1, 2020 100%
W-2 Managing EmployeeCfo Jan 1, 2020 100%
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018
Jerry Starkey Individual Corporate Director Jan 1, 2020

Practitioners & affiliated clinicians

Practitioners 94

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 94

NPI Registry JSON

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

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1679124010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12655 COLLIER BLVD",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341164005",
            "telephone_number": "239-658-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136"
    },
    "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": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.