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Choptank Community Health System Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · St Michaels, MD

NPI 1679790299 · NPPES record last updated Oct 30, 2020

Key facts

NPI
1679790299
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
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
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 24

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

Practitioners 47

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

View all 47

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

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
Corporation · Non-profit
Incorporated
Jan 20, 1978 in MD
Enrollment address
933 S Talbot St
Unit 4
St Michaels, MD 21663-2605

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 Director
Board Member		 Jan 1, 2011
Benjamin Cottle
Individual 		Corporate Officer
Cfo		 Jul 16, 2018
Jennifer W Yost
Individual 		Corporate Director
Board Member		 Feb 1, 2015
Sara K Rich
Individual 		Corporate Officer
Ceo		 Jan 1, 2017
Patrick W Thomas
Individual 		Corporate Director
Board Member		 Jan 1, 2019
Rebecca Loukides
Individual 		Corporate Director
Board Member		 Aug 1, 2016
Crystal L Dadds
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Ivonne Garrido
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Matthew R Peters
Individual 		Corporate Director
Board Member		 Apr 1, 2015
Gary L Long
Individual 		Corporate Officer
Chief Operations Officer		 Mar 6, 2017
Pauline E Pinkett
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Kimberly R Love
Individual 		W-2 Managing Employee
Finance Director		 Feb 19, 2002
Sara B Visintainer
Individual 		Corporate Director
Board Member		 Feb 1, 2015

Medicare enrollment records

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

National Provider Directory

Tax ID family
Choptank Community Health System Inc (103 organizations share this tax ID)

Locations

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

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

Specialties & licenses

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

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

  • Bay Hundred Health Center Doing business as

Other providers in St Michaels, MD

All providers in St Michaels, MD · Federally Qualified Health Center (FQHC) in Maryland

Sources for this page

Verify at the official NPI Registry.