NPIMap

Organization Active NPI

District Clinic Holdings Inc

  • Federally Qualified Health Center (FQHC)
  • West Palm Beach, FL
National Provider Identifier
1679810469
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DISTRICT CLINIC HOLDINGS INC
Practice address
1150 45TH St
West Palm Beach, FL 33407
Phone
(561) 842-7383
Fax
(561) 439-4446
NPI assigned
Jan 14, 2013
Last updated
Mar 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Darcy Davis
Title
Ceo
Phone
(561) 804-5885

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1150 45TH St
West Palm Beach, FL 33407

Mailing address

1515 N Flagler Dr Ste 101
West Palm Beach, FL 33401-3429
Phone (561) 833-9469

Other identifiers 2

IdentifierTypeStateIssuer
008037106MedicaidFL
008037107MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130524000423 FL Part B Supplier - Clinic/Group Practice 6507955432 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riviera Beach, FL
O20150107000037 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486876000 Practice locations: West Palm Beach, FL
O20260527002294 FL Part B Supplier - Clinic/Group Practice 4486876000 Receives reassigned benefits from 25 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Palm Beach, FL; Delray Beach, FL; Jupiter, FL; Boca Raton, FL; Belle Glade, FL; Palm Springs, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679810469. Details of each certification follow.

Federally qualified health center certification: CCN 101194

Legal name
DISTRICT CLINIC HOLDINGS INC
Doing business as
CL BRUMBACK PRIMARY CARE CLINIC, WEST PALM BEACH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 7, 2015
Last certification
Jan 7, 2015
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 31, 2012 in FL
Enrollment address
1150 45TH St
West Palm Beach, FL 33407-2361

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
District Clinic Holdings Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1515 N Flagler Dr
Ste 101
West Palm Beach, FL 33401
Phone (561) 659-1270

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Candice R Abbott Individual Corporate OfficerChief Financial Officer Feb 1, 2021
Operational/Managerial ControlChief Financial Officer Feb 1, 2021
District Clinic Holdings Inc Organization, West Palm Beach, FL Non-profit Operational/Managerial Control Aug 1, 2014 100%
Darcy Davis Individual Corporate OfficerCfo Aug 26, 2014
Operational/Managerial ControlCeo May 24, 2019

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
CL Brumback Primary Care Clinic, LantanaLantana, FL, CCN 101184 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, DelrayDelray Beach, FL, CCN 101190 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic Belle GladeBelle Glade, FL, CCN 101189 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, Lewis CenterWest Palm Beach, FL, CCN 681017 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinics, Lake WorthLake Worth, FL, CCN 681059 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 28, 2015
Jul 28, 2015
CL Brumback Primary Care Clinic, Boca RatonBoca Raton, FL, CCN 681087 Federally qualified health center Operational/Managerial Control Apr 10, 2017
District Clinic Holdings IncJupiter, FL, CCN 681088 Federally qualified health center Operational/Managerial Control Mar 6, 2017
CL Brumback Primary Care Clinic Mangonia ParkWest Palm Beach, FL, CCN 681160 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 15, 2019
Oct 15, 2019
Health Care District Community Health CenterPalm Springs, FL, CCN C11056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 12, 2025

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 9

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": "1358121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1679810469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N FLAGLER DR STE 101",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334013429",
            "telephone_number": "561-833-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 45TH ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33407",
            "telephone_number": "561-842-7383",
            "fax_number": "561-439-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT CLINIC HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-14",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DARCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-804-5885"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008037106",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008037107",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.