NPIMap

Organization Active NPI

Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
National Provider Identifier
1679877138
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEAK VISTA COMMUNITY HEALTH CENTERS
Practice address
3205 N Academy Blvd Ste 120
Colorado Springs, CO 80917-5147
Phone
(719) 632-5700
Fax
(719) 344-7840
NPI assigned
Dec 27, 2010
Organization subpart
Yes
Parent organization
PEAK VISTA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Authorized official

Name
Ryan Spillane
Title
Chief Financial Officer
Phone
(719) 344-7135

Specialties & licenses 1

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

Addresses

Primary practice location

3205 N Academy Blvd Ste 120
Colorado Springs, CO 80917-5147

Mailing address

3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone (719) 632-5700

Other identifiers 2

IdentifierTypeStateIssuer
32953771MedicaidCO
05638267MedicaidCO

Other names 1

  • Developmental Disabilities Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030311000017 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 2 other NPIs on this enrollment
Practice locations: Colorado Springs, CO

Federally qualified health center certification: CCN 061878

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
DEVELOPMENTAL DISABILITIES HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2003
Last certification
Jul 11, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
3205 N Academy Blvd
Ste 120
Colorado Springs, CO 80917-5147
Related CCNs
061833

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 23

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

View all 23

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Peak Vista Community Health Center27 organizations share this tax ID, including this one
Part of
Peak Vista Community Health Center

Other organizations with this tax ID 26

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

View all 26

Locations

3205 N Academy Blvd
Ste 120
Colorado Springs, CO 80917
Phone (719) 344-6155

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
William C Sanden Individual Corporate DirectorBoard Member Jan 1, 2019
Ray Nunn Individual Corporate DirectorBoard Member Oct 1, 2019
Ryan Spillane Individual Corporate OfficerChief Financial Officer Sep 26, 2022
Dennis Smialek Individual Corporate DirectorBoard Member Mar 3, 2020
Santiago R Duran Individual Corporate DirectorBoard Member Jul 1, 2010
John Eastman Individual Corporate DirectorBoard Member Jan 18, 2024
Gertrud M Horvath Individual Corporate DirectorBoard Member Feb 7, 2017
Rocio Rodriguez Individual Corporate DirectorBoard Member Sep 1, 2023
Mary M Sheetz Individual Corporate DirectorBoard Member Jan 9, 2018
Leila P Gibson-Green Individual Corporate DirectorBoard Member Dec 1, 2022
Fadi Youkhana Individual Corporate DirectorBoard Member Jun 1, 2023
Stella U Hodgkins Individual Corporate DirectorBoard Member Nov 1, 2022
Denise Smith Silva Individual W-2 Managing EmployeeBusiness Systems Manager Mar 31, 1987
David Fairley Individual Corporate DirectorBoard Member Jun 1, 2022

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mobile Health Services VanColorado Springs, CO, CCN 061909 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 15, 2012
Logan Health Center at Myron StrattonColorado Springs, CO, CCN 061914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012
Pediatric Health CenterColorado Springs, CO, CCN 061917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 126

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

View all 126

NPI Registry JSON

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

{
    "created_epoch": "1293408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1679877138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD STE 120",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175147",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2010-12-27",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "719-344-7135"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32953771",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638267",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Developmental Disabilities Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Developmental Disabilities Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.