NPIMap

Organization Active NPI

The Metrohealth System

Doing business as Gordon Square Health Center

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
National Provider Identifier
1700639358
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE METROHEALTH SYSTEM
Doing business as
Gordon Square Health Center
Practice address
6705 Detroit Ave
Cleveland, OH 44102-3017
Phone
(216) 957-4905
NPI assigned
Apr 11, 2024
Last updated
May 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Derrick Hollings
Title
Evp/Cfo
Phone
(216) 778-7800

Specialties & licenses 1

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

Addresses

Primary practice location

6705 Detroit Ave
Cleveland, OH 44102-3017

Mailing address

6705 Detroit Ave
Cleveland, OH 44102-3017
Phone (216) 957-4905

Other names 1

  • Gordon Square Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241001004298 OH Part A Provider - Federally Qualified Health Center (FQHC) 8628982949 Practice locations: Cleveland, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700639358. Details of each certification follow.

Federally qualified health center certification: CCN D21050

Legal name
THE METROHEALTH SYSTEM
Doing business as
GORDON SQUARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 26, 2024
Last certification
Sep 26, 2024
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
6705 Detroit Ave
Cleveland, OH 44102-3017

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Metrohealth Dept of Psy38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

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
Ezelle Harry Walker Individual Corporate DirectorBoard Member Feb 2, 2024
Richard Kevin Borowiak Individual Corporate DirectorBoard Member Feb 2, 2024
Mellany Melinda Seay Individual Corporate Officer Feb 2, 2024
Eric Brandon Williams Individual Corporate DirectorBoard Member Feb 2, 2024
Katherine Nagel Individual Corporate OfficerChief Executive Officer Feb 2, 2024
Brenda Roth-Metzger Individual Corporate DirectorBoard Member Feb 2, 2024
Joseph Varga Individual W-2 Managing Employee Feb 2, 2024
Debra Abercrumbie Individual Corporate DirectorBoard Member Feb 2, 2024
Linda Ryan-Allen Individual Corporate DirectorBoard Chair Feb 2, 2024
Ron Fountain Individual Corporate DirectorBoard Member Feb 2, 2024
Shirley Jordan Seay Individual Corporate DirectorBoard Member Feb 2, 2024
The Metrohealth System Organization, Cleveland, OH 5% Or Greater Direct Ownership Interest Feb 2, 2024 100%
Ruby Jean Black Individual Corporate DirectorBoard Member Feb 2, 2024

Owners & managing parties with NPI records 23

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 23

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Broadway Dental ClinicCleveland, OH, CCN 721941 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Brooklyn Health CenterCleveland, OH, CCN D21051 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 2024
Heights Wellnes CenterCleveland Heights, OH, CCN D21074 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 7, 2024
Collinwood Health CenterCleveland, OH, CCN D21063 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 7, 2024
Buckeye Health CenterCleveland, OH, CCN D21067 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 7, 2024
Bedford Health CenterBedford, OH, CCN D21072 Federally qualified health center 5% Or Greater Direct Ownership Interest Feb 7, 2024

Owned or controlled facilities with NPI records 6

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

  • The Metrohealth System

    dba Bedford Health Center

    • Federally Qualified Health Center (FQHC)
    • Bedford, OH
    • NPI 1255184800

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • The Metrohealth System

    dba MetroHealth Broadway Health Center

    • Federally Qualified Health Center (FQHC)
    • Cleveland, OH
    • NPI 1346919362

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • The Metrohealth System

    dba Brooklyn Health Center

    • Federally Qualified Health Center (FQHC)
    • Cleveland, OH
    • NPI 1558114108

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • The Metrohealth System

    dba Buckeye Health Center

    • Federally Qualified Health Center (FQHC)
    • Cleveland, OH
    • NPI 1710730361

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • The Metrohealth System

    dba Collinwood Health Center

    • Federally Qualified Health Center (FQHC)
    • Cleveland, OH
    • NPI 1780437335

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • The Metrohealth System

    dba Heights Wellness Center

    • Federally Qualified Health Center (FQHC)
    • Cleveland Heights, OH
    • NPI 1861245417

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1700639358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6705 DETROIT AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441023017",
            "telephone_number": "216-957-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6705 DETROIT AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441023017",
            "telephone_number": "216-957-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE METROHEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "HOLLINGS",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "216-778-7800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gordon Square Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gordon Square Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.