NPIMap

Organization Active NPI

Lowell Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lowell, MA
National Provider Identifier
1689092595
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
4VAC Issued in MA
Legal business name
LOWELL COMMUNITY HEALTH CENTER, INC.
Practice address
101 Jackson St
Lowell, MA 01852-2103
Phone
(978) 441-1700
NPI assigned
Mar 29, 2014
Last updated
Sep 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

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

Authorized official

Name
Susan West Levine
Title
Ceo
Phone
(978) 322-8590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 4VAC MA Primary

Addresses

Primary practice location

101 Jackson St
Lowell, MA 01852-2103

Mailing address

161 Jackson St
Lowell, MA 01852-2103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040804001749 MA Part B Supplier - Clinic/Group Practice 6204807944 Receives reassigned benefits from 137 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lowell, MA
O20041028000057 MA Part A Provider - Federally Qualified Health Center (FQHC) 6204807944 1 other NPI on this enrollment
Practice locations: Lowell, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689092595. Details of each certification follow.

Federally qualified health center certification: CCN 221863

Legal name
LOWELL COMMUNITY HEALTH CENTER, INC.
Doing business as
LOWELL COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 10, 2004
Last certification
Dec 10, 2004
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Aug 28, 1985 in MA
Enrollment address
101 Jackson St
Lowell, MA 18522103
Related CCNs
221815

Other NPIs with the same Medicare PAC ID 2

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
Lowell Community Health Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Richard Dionne Individual Corporate DirectorBoard Member Jun 17, 2015
Susanne Beaton Individual Corporate DirectorBoard Member Jun 1, 2004
Alba Hernandez Individual W-2 Managing EmployeePayer Contracts Manager Jun 19, 2017
Bopha Boutselis Individual Corporate DirectorBoard Member Nov 16, 2022
Timothy J Regan Individual W-2 Managing EmployeeSenior Director of Compliance Dec 17, 2018
Christopher Cridler Individual Corporate DirectorBoard Member Nov 15, 2023
Javier Ramos Individual Other May 26, 2024
Terry T Howard Individual Corporate DirectorBoard Member Jun 1, 2002
Mary P Gallant Chang Individual Corporate DirectorBoard Member Nov 15, 2023
Mayte Ramos Individual Corporate DirectorBoard Member Jun 1, 2013
Mariatou Allie-Dumbuya Individual Corporate DirectorBoard Member Jun 1, 2002
Dorris Umunna Individual Corporate OfficerBoard Member Jun 1, 2017
Safeena Niazi Individual Corporate DirectorBoard Member Nov 15, 2023
Maria Cunha Individual Corporate DirectorBoard Member Jun 1, 2011
Diego Leonardo-Garcia Individual Corporate DirectorBoard Member Jun 16, 2021
Patrick Curtin Individual Corporate OfficerChief Financial Officer Sep 30, 2024
Stephen Laput Individual Corporate DirectorBoard Member Jun 1, 2012
Caroline Duong Individual Corporate DirectorBoard Chair Jun 19, 2019
Alessandra Fisher Individual Corporate DirectorBoard Member Jun 19, 2019
Bawo Ebigbeyi-Alozie Individual Corporate Officer Sep 30, 2024
Carrie C Main Individual W-2 Managing EmployeeSenior Director Or Finance Feb 7, 2022
Keary T Allicon Individual Corporate DirectorBoard Member Jan 18, 2023
Susan West Levine Individual Corporate OfficerChief Executive Officer Jun 27, 2016
Litmarie Reyes Individual W-2 Managing EmployeeRevenue Cycle Manager Jul 9, 2018
Elizabeth Wando Individual Corporate DirectorBoard Member May 17, 2017
Sangita Stearns Pillai Individual Corporate DirectorBoard Member Nov 14, 2018
Bruce Tyler Robinson Individual Corporate DirectorBoard Member Jul 1, 2007

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1396051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536537600000",
    "number": "1689092595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 JACKSON ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018522103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 JACKSON ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018522103",
            "telephone_number": "978-441-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWELL COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-29",
        "last_updated": "2018-09-10",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "WEST",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-322-8590"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MA",
            "license": "4VAC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, MA

Sources for this page

Verify at the official NPI Registry.