NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as Bay Hundred Health Center

  • Federally Qualified Health Center (FQHC)
  • St. Michael's, MD
National Provider Identifier
1679790299
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
Bay Hundred Health Center
Practice address
933 S Talbot St
Unit 4
St Michaels, MD 21663-2633
Phone
(410) 745-0200
Fax
(833) 908-2281
NPI assigned
Apr 18, 2007
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

933 S Talbot St
Unit 4
St Michaels, MD 21663-2633

Mailing address

933 S Talbot St Ste 4
St Michaels, MD 21663-2605
Phone (410) 745-0200

Other names 1

  • Bay Hundred 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
O20030214000018 MD Part A Provider - Federally Qualified Health Center (FQHC) 0648189274 1 other NPI on this enrollment
Practice locations: St Michaels, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679790299. Details of each certification follow.

Federally qualified health center certification: CCN 211830

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 3, 2003
Last certification
Jun 3, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
933 S Talbot St
Unit 4
St Michaels, MD 21663-2605

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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

303 Sharp Rd
Denton, MD 21629
Phone (410) 463-9418

522 Cynwood Dr
Ste 100
Easton, MD 21601
Phone (410) 770-8910

8579 Commerce Dr
Ste 104
Easton, MD 21601
Phone (410) 822-8550

25390 Richardson Rd
Federalsburg, MD 21632
Phone (410) 754-9580

627 N Main St
Greensboro, MD 21639
Phone (410) 479-3885

200 Seymour Ave
St Michaels, MD 21663
Phone (410) 745-2852

300 S Church St
Sudlersville, MD 21668
Phone (410) 482-9148

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
John Masone Individual Corporate DirectorBoard Member Jan 1, 2011
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
Patrick W Thomas Individual Corporate DirectorBoard Member Jan 1, 2019
Rebecca Loukides Individual Corporate DirectorBoard Member Aug 1, 2016
Crystal L Dadds Individual Corporate DirectorBoard Member Jan 1, 2016
Ivonne Garrido Individual Corporate DirectorBoard Member Jan 1, 2017
Matthew R Peters Individual Corporate DirectorBoard Member Apr 1, 2015
Gary L Long Individual Corporate OfficerChief Operations Officer Mar 6, 2017
Pauline E Pinkett Individual Corporate DirectorBoard Member Jan 1, 2016
Kimberly R Love Individual W-2 Managing EmployeeFinance Director Feb 19, 2002
Sara B Visintainer Individual Corporate DirectorBoard Member Feb 1, 2015

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1679790299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 S TALBOT ST STE 4",
            "city": "ST MICHAELS",
            "state": "MD",
            "postal_code": "216632605",
            "telephone_number": "410-745-0200",
            "fax_number": "339-082-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 S TALBOT ST",
            "address_2": "UNIT 4",
            "city": "ST MICHAELS",
            "state": "MD",
            "postal_code": "216632633",
            "telephone_number": "410-745-0200",
            "fax_number": "833-908-2281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "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": "Bay Hundred Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bay Hundred Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St. Michael's, MD

Sources for this page

Verify at the official NPI Registry.