NPIMap

Organization Active NPI

Community Health Programs

Doing business as CHP Lee Family Practice

  • Community Health Clinic/Center
  • Lee, MA
National Provider Identifier
1689945784
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
4COJ Issued in MA
Legal business name
COMMUNITY HEALTH PROGRAMS
Doing business as
CHP Lee Family Practice
Practice address
CHP Lee Family Practice
11 Quarry Hill Road
Lee, MA 01238
Phone
(413) 243-0536
Fax
(413) 243-8040
NPI assigned
Jan 20, 2012
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Karen Johnson
Title
Chief Human Resources and Complianc
Phone
(413) 528-9311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 4COJ MA Primary

Addresses

Primary practice location

CHP Lee Family Practice
11 Quarry Hill Road
Lee, MA 01238

Mailing address

P.O. Box 30
Great Barrington, MA 01230
Phone (413) 528-9311

Other names 1

  • CHP Lee Family Practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041025000193 MA Part B Supplier - Clinic/Group Practice 5799746608 Receives reassigned benefits from 104 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adams, MA; Great Barrington, MA; Lee, MA; North Adams, MA; Pittsfield, MA
O20120223000398 MA Part A Provider - Federally Qualified Health Center (FQHC) 5799746608 Practice locations: Lee, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689945784. Details of each certification follow.

Federally qualified health center certification: CCN 221909

Legal name
COMMUNITY HEALTH PROGRAMS INC
Doing business as
CHP LEE FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 29, 2012
Last certification
Feb 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 25, 1975 in MA
Enrollment address
11 Quarry Hill Rd
Lee, MA 12389645

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Programs12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

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
Brian Drake Individual Corporate OfficerBoard Member Jan 1, 2022 100%
Thomas Walbridge Individual Corporate DirectorCfo Jan 1, 2022 100%
Operational/Managerial ControlCfo Jan 1, 2022 100%
Christopher Phillips Individual Corporate OfficerBoard Member Dec 12, 2022

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1689945784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 30",
            "city": "GREAT BARRINGTON",
            "state": "MA",
            "postal_code": "01230",
            "telephone_number": "413-528-9311",
            "fax_number": "413-644-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CHP LEE FAMILY PRACTICE",
            "address_2": "11 QUARRY HILL ROAD",
            "city": "LEE",
            "state": "MA",
            "postal_code": "01238",
            "telephone_number": "413-243-0536",
            "fax_number": "413-243-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH PROGRAMS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CHIEF HUMAN RESOURCES AND COMPLIANC",
        "authorized_official_telephone_number": "413-528-9311"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "MA",
            "license": "4COJ",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHP Lee Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CHP Lee Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lee, MA

Sources for this page

Verify at the official NPI Registry.