NPIMap

Organization Active NPI

Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Enfield, CT
National Provider Identifier
1679761027
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER INC
Practice address
5 N Main St
Enfield, CT 06082-3339
Phone
(860) 253-9024
Fax
(860) 253-9124
NPI assigned
Oct 11, 2007
Last updated
Oct 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Ms. Bain Patrie
Title
Credentialing Specialist
Phone
(860) 347-6971

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X CT
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5 N Main St
Enfield, CT 06082-3339

Mailing address

575 Main St FL 2
Attn: Credentialing Dept
Middletown, CT 06457-2845
Phone (860) 347-6971

Other names 1

  • Mary Lou Strom Primary Care Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090824000512 CT Part A Provider - Federally Qualified Health Center (FQHC) 0547169138 Practice locations: Enfield, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679761027. Details of each certification follow.

Federally qualified health center certification: CCN 071850

Legal name
COMMUNITY HEALTH CENTER INC
Doing business as
COMMUNITY HEALTH CENTER OF ENFIELD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2009
Last certification
Dec 14, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
5N Main St
Enfield, CT 60823372

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
CHC of Meriden30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Community Health Center Inc Organization, Middletown, CT 5% Or Greater Direct Ownership Interest Sep 1, 2000
Al Miles Individual Corporate Director Oct 9, 2008
Gary Reid Individual Corporate Director Sep 1, 2000
Mark Bonney Individual Corporate Director Sep 1, 2000
Angela Anthony Individual Corporate Director Sep 1, 2003
Mark Masselli Individual Corporate Director Sep 1, 2000
W-2 Managing Employee Sep 1, 2000
Donald J Case Individual Corporate Director Sep 1, 2000
David Vance Individual Corporate Director Sep 1, 2000
Terry Danaher Individual Corporate Director Sep 1, 2000
Maragaret Flinter Individual Corporate Director Sep 1, 2000
W-2 Managing Employee Sep 1, 2000
Jill Maconi Individual Corporate Director Dec 15, 2008

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Center of DanburyDanbury, CT, CCN 071849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1679761027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MAIN ST FL 2",
            "address_2": "ATTN: CREDENTIALING DEPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572845",
            "telephone_number": "860-347-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 N MAIN ST",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823339",
            "telephone_number": "860-253-9024",
            "fax_number": "860-253-9124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-11",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "PATRIE",
        "authorized_official_first_name": "BAIN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "860-347-6971",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Lou Strom Primary Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Enfield, CT

Sources for this page

Verify at the official NPI Registry.