NPIMap

Organization Active NPI

Community Health Care

Doing business as Key Medical Center

  • Community Health Clinic/Center
  • Lakebay, WA
National Provider Identifier
1699375345
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY HEALTH CARE
Doing business as
Key Medical Center
Practice address
15610 89TH St. CT. KPN
Lakebay, WA 98349-9840
Phone
(253) 597-4550
NPI assigned
Oct 30, 2020
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
David Flentge
Title
President/Ceo
Phone
(253) 597-4550

Specialties & licenses 1

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

Addresses

Primary practice location

15610 89TH St. CT. KPN
Lakebay, WA 98349-9840

Mailing address

1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 597-4550

Other names 1

  • Key Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211201001934 WA Part A Provider - Federally Qualified Health Center (FQHC) 1850201559 Practice locations: Lakebay, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699375345. Details of each certification follow.

Federally qualified health center certification: CCN 501001

Legal name
COMMUNITY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 2, 2021
Last certification
Dec 2, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Apr 24, 1987 in WA
Enrollment address
15610 89TH Street CT NW
Lakebay, WA 98349-9551

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Chcds-Lakewood Clinic34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
David Flentge Individual Corporate Director Jan 19, 2011 100%
W-2 Managing Employee Mar 16, 2011 100%

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1699375345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 BROADWAY STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023518",
            "telephone_number": "253-597-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15610 89TH ST. CT. KPN",
            "city": "LAKEBAY",
            "state": "WA",
            "postal_code": "983499840",
            "telephone_number": "253-597-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "FLENTGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "253-597-4550"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Key Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakebay, WA

Sources for this page

Verify at the official NPI Registry.