NPIMap

Organization Active NPI

Moses Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Moses Lake, WA
National Provider Identifier
1699862813
Registry record updated Aug 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
601352250 Issued in WA
Legal business name
MOSES LAKE COMMUNITY HEALTH CENTER
Practice address
605 S Coolidge St
Moses Lake, WA 98837-1893
Phone
(509) 765-0674
Fax
(509) 765-6591
NPI assigned
Oct 8, 2006
Last updated
Aug 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2014

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

Authorized official

Name
Ms. Sheila A Chilson
Title
Chief Executive Officer
Phone
(509) 765-0674

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 601352250 WA Primary

Addresses

Primary practice location

605 S Coolidge St
Moses Lake, WA 98837-1893

Mailing address

605 S Coolidge St
Moses Lake, WA 98837-1893
Phone (509) 765-0674

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000667 WA Part B Supplier - Clinic/Group Practice 1254235138 Receives reassigned benefits from 157 practitioners
Practice locations: Moses Lake, WA; Quincy, WA
O20110126000043 WA Part A Provider - Federally Qualified Health Center (FQHC) 1254235138 Practice locations: Moses Lake, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699862813. Details of each certification follow.

Federally qualified health center certification: CCN 501891

Legal name
MOSES LAKE COMMUNITY HEALTH CENTER
Doing business as
QUINCY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 7, 2005
Last certification
Dec 7, 2005
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Dec 3, 1991 in WA
Enrollment address
605 S Coolidge St
Moses Lake, WA 98837-1893

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

605 S Coolidge St
#101
Moses Lake, WA 98837
Phone (509) 765-0674

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Amalia Campos Individual Corporate OfficerBoard Member Dec 17, 2012
Amy Raymond Individual Corporate DirectorBoard Member Nov 24, 2010
Sharon Lange Individual Corporate DirectorBoard Member Nov 24, 2010
Sheila Chilson Individual Corporate OfficerCeo Nov 24, 2010
Corporate DirectorCeo Nov 24, 2010
W-2 Managing EmployeeCeo Feb 4, 2012 100%
Sheryl Delgado Individual Corporate DirectorBoard Member Nov 24, 2010
Matthew Benson Individual Corporate OfficerBoard Member Jun 1, 2011
Amanda Barta Individual Corporate OfficerCfo Mar 1, 2014
Corporate DirectorCfo Mar 1, 2014
Carol Schimke Individual Corporate DirectorBoard Member Nov 24, 2010

Practitioners & affiliated clinicians

Practitioners 176

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 176

NPI Registry JSON

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

{
    "created_epoch": "1160265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406851200000",
    "number": "1699862813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-765-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-765-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES LAKE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-08",
        "last_updated": "2014-08-01",
        "status": "A",
        "authorized_official_last_name": "CHILSON",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "509-765-0674",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "601352250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.