NPIMap

Organization Active NPI

Christ Community Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
National Provider Identifier
1699922401
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES, INC
Practice address
1325 Jefferson Ave
Memphis, TN 38104-2013
Phone
(901) 701-2530
Fax
(901) 701-2536
NPI assigned
Aug 22, 2008
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Mr. Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Specialties & licenses 1

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

Addresses

Primary practice location

1325 Jefferson Ave
Memphis, TN 38104-2013

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 842-3160

Other identifiers 2

IdentifierTypeStateIssuer
3707256OtherTNMEDICAID GROUP NUMBER
3707256OtherTNMEDICARE GROUP NUMBER

Other names 1

  • Mobile Van Service Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20130415000054 TN Part A Provider - Federally Qualified Health Center (FQHC) 3870402084 Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699922401. Details of each certification follow.

Federally qualified health center certification: CCN 441890

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 19, 2004
Last certification
Apr 19, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in TN
Enrollment address
2861 Broad Ave
Memphis, TN 38112-2903
Related CCNs
441809

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

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Locations

1325 Jefferson Ave
Memphis, TN 38104
Phone (901) 701-2530

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Shantelle N Leatherwood Individual Corporate OfficerCeo Jan 1, 2017
W-2 Managing EmployeeCeo Jan 1, 2017
Marlon Wesley Brown Individual Corporate Director Jan 26, 2011
Ernest Porter Individual Corporate Director Jan 26, 2011
Larry Bishop Lloyd Individual Corporate Director Jan 26, 2011
Rebecca Kernan Individual Corporate Director Jan 26, 2011
Leah Hillis Individual Corporate Director Jan 26, 2011
Norma L Hunt Individual Corporate Director Jan 26, 2011
Daisy Diaz Individual Corporate Director Jan 26, 2011
Carolyn G Agapos Individual Corporate Director Jan 26, 2011
Marcus E Lewis Individual Corporate Director Jan 26, 2011
Barbara Fant Individual Corporate Director Jan 26, 2011
John Ross Dyer Individual Corporate Director Jan 26, 2011

Practitioners & affiliated clinicians

Practitioners 11

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": "1219363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1699922401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 UNION AVENUE EXT STE 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124416",
            "telephone_number": "901-842-3160",
            "fax_number": "901-260-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042013",
            "telephone_number": "901-701-2530",
            "fax_number": "901-701-2536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-22",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-842-3160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Van Service",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mobile Van Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.