NPIMap

Organization Active NPI

Jessie Trice Community Health System, Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1689605362
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5143177 Issued in FL
Legal business name
JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Practice address
5361 NW 22ND Ave
Miami, FL 33142-8035
Phone
(305) 637-6400
Fax
(305) 636-5155
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Ryan R. Hawkins
Title
President & Ceo
Phone
(305) 805-1700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X 5143177 FL Primary

Addresses

Primary practice location

5361 NW 22ND Ave
Miami, FL 33142-8035

Mailing address

5607 NW 27TH Ave
Suite 1
Miami, FL 33142-2826
Phone (305) 805-1700

Other identifiers 4

IdentifierTypeStateIssuer
029541800MedicaidFL
053833700MedicaidFL
060826200MedicaidFL
029541801MedicaidFL

Other names 2

  • Jessie Trice Community Health Center Inc Former legal business name
  • JTCHS Fatima Zafar MD Health Wellness Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041020000714 FL Part B Supplier - Clinic/Group Practice 2961486733 Receives reassigned benefits from 59 practitioners
16 other NPIs on this enrollment
Practice locations: Miami, FL; Opa Locka, FL; Miami Gardens, FL; Hialeah, FL
O20081018000260 FL Part A Provider - Federally Qualified Health Center (FQHC) 2961486733 Practice locations: Miami, FL

Federally qualified health center certification: CCN 101801

Legal name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1967 in FL
Enrollment address
5361 NW 22ND Ave
Miami, FL 33142-8035

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Locations

5607 NW 27th Ave
Ste 2
Miami, FL 33142
Phone (305) 636-3336

1190 NW 95th St
Ste 100
Miami, FL 33150
Phone (305) 534-4404

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Ryan Hawkins Individual Corporate DirectorPresident/Ceo Mar 1, 2024
W-2 Managing EmployeeAd; Mar 1, 2024
Irene N Taylor-Wooten Individual Corporate DirectorBoard of Directors Jan 1, 2010
Belita Wyatt Individual Corporate OfficerBoard of Directors Feb 1, 2012
Corporate DirectorBoard of Directors Feb 1, 2012
Janice Ricketts Individual Corporate DirectorBoard of Directors Jan 1, 2010
Latonya S Sautier Individual Corporate DirectorBoard of Directors Jan 1, 2010
Paul Roberts Individual Corporate DirectorBoard of Directors Jan 1, 2010
Tishria L Mindingall Individual Corporate DirectorBoard of Directors Jan 1, 2010
Lenora Yates Individual Corporate DirectorBoard of Directors Jan 1, 2010
Angela D Lightfoot Individual Corporate DirectorBoard of Directors Jan 1, 2010
Carla Jones Individual Corporate DirectorBoard of Directors Jan 1, 2010
Thamara R Labrousee Individual Corporate DirectorBoard of Directors Jan 1, 2010
Terrell G West Individual Corporate DirectorBoard of Directors Jan 1, 2010
Sherwood G Dubose Individual Corporate DirectorBoard of Directors Jan 1, 2010
David Williams Individual Corporate DirectorBoard of Directors Jan 1, 2010
Robert L Thomas Individual Corporate DirectorBoard of Directors Jan 1, 2010

Practitioners & affiliated clinicians

Practitioners 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1689605362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 NW 27TH AVE",
            "address_2": "SUITE 1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331422826",
            "telephone_number": "305-805-1700",
            "fax_number": "305-805-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5361 NW 22ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331428035",
            "telephone_number": "305-637-6400",
            "fax_number": "305-636-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "305-805-1700"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "FL",
            "license": "5143177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029541800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053833700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060826200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029541801",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessie Trice Community Health Center Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "JTCHS Fatima Zafar MD Health Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.