NPIMap

Organization Active NPI

Escambia Community Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Milton, FL
National Provider Identifier
1689864035
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESCAMBIA COMMUNITY CLINICS, INC
Practice address
6671 Caroline St
Milton, FL 32570-4781
Phone
(850) 981-9433
Fax
(850) 981-9436
NPI assigned
Jul 31, 2007
Organization subpart
Yes
Parent organization
ESCAMBIA COMMUNITY CLINICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Authorized official

Name
Chandra Smiley
Title
Executive Director
Phone
(850) 436-4630

Specialties & licenses 1

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

Addresses

Primary practice location

6671 Caroline St
Milton, FL 32570-4781

Mailing address

2315 W Jackson St
Pensacola, FL 32505-7552
Phone (850) 436-4630

Other identifiers 1

IdentifierTypeStateIssuer
692990702MedicaidFL

Other names 2

  • Milton Doing business as
  • Santa Rosa Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160224000026 FL Part A Provider - Federally Qualified Health Center (FQHC) 9638165806 Practice locations: Milton, FL

Federally qualified health center certification: CCN 681039

Legal name
ESCAMBIA COMMUNITY CLINICS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2016
Last certification
Feb 24, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in FL
Enrollment address
6671 Caroline St
Milton, FL 32570-4781

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Alan Pendergrass MD

Locations

470 S Highway 29
Ste B
Cantonment, FL 32533
Phone (507) 800-1118

470 S Highway 29
Cantonment, FL 32533
Phone (850) 780-0111

5375 N 9th Ave
Ste A
Pensacola, FL 32504
Phone (850) 760-0669

1380 N Palafox St
Pensacola, FL 32501
Phone (850) 512-1430

350 W Herman St
Pensacola, FL 32505
Phone (850) 332-5900

2701 N Q St
#C
Pensacola, FL 32505

Ownership & related parties

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
Grace McCaffery Individual Corporate DirectorBoard Member Jul 29, 2021
Bob Wilson Individual Corporate DirectorBoard Member Sep 1, 2007
Freddie Cattouse Individual Corporate DirectorBoard Member Sep 1, 2007
Dorothy Foster Individual Corporate DirectorBoard Member Apr 1, 2017
Ann Osiname Individual Corporate DirectorBoard Member Sep 1, 2017
Walter Ritchie Individual Corporate DirectorBoard Member Sep 1, 2017
Chandra Smiley Individual Corporate OfficerExecutive Director Dec 1, 2014
W-2 Managing EmployeeExecutive Director Dec 1, 2014
Operational/Managerial ControlExecutive Director Dec 1, 2014
Jules Kariher Individual Corporate DirectorBoard Member - Vice Chairman Oct 1, 2017
Justin H Labrato Individual Corporate DirectorBoard Member - Treasurer Mar 1, 2014
Joseph Emmanuel Individual Corporate DirectorBoard Member Sep 1, 2007
Brett Aldridge Individual Corporate DirectorBoard Member Jul 1, 2018
John T Porter Individual Corporate DirectorBoard Member - Chairman Sep 1, 2017
Sean Seely Individual Corporate DirectorBoard Member Apr 1, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Northwest FloridaPensacola, FL, CCN 681048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 29, 1992
Community Health Northwest FloridaPensacola, FL, CCN 681849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1689864035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6671 CAROLINE ST",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325704781",
            "telephone_number": "850-981-9433",
            "fax_number": "850-981-9436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCAMBIA COMMUNITY CLINICS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "enumeration_date": "2007-07-31",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-436-4630"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "692990702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Milton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Rosa Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Santa Rosa Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milton, FL

Sources for this page

Verify at the official NPI Registry.