NPIMap

Community Health Center Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Enfield, CT

NPI 1679761027 · NPPES record last updated Oct 30, 2012

Key facts

NPI
1679761027
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 13

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 13

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

Corporate family (same tax ID) 29

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

View all 29

Facilities with the same owner 1

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

Practitioners 149

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

View all 149

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CT

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
Corporation · Non-profit
Enrollment address
5N Main St
Enfield, CT 60823372

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

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 Danbury
Danbury, CT · CCN 071849		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2000

Medicare enrollment records

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

National Provider Directory

Tax ID family
Community Health Center (30 organizations share this tax ID)

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
004236346MedicaidCT
004236338MedicaidCT

Other names

  • Mary Lou Strom Primary Care Center Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 30, 2012.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236338",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Lou Strom Primary Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Enfield, CT

All providers in Enfield, CT · Federally Qualified Health Center (FQHC) in Connecticut

Sources for this page

Verify at the official NPI Registry.