NPIMap

Organization Active NPI

Im Sulzbacher Center for the Homeless, Inc

Doing business as Sulzbacher Center

  • Federally Qualified Health Center (FQHC)
  • Jacksonville, FL
National Provider Identifier
1710051354
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
6860320 00 Issued in FL
Legal business name
IM SULZBACHER CENTER FOR THE HOMELESS, INC
Doing business as
Sulzbacher Center
Practice address
611 E Adams St
Jacksonville, FL 32202-2847
Phone
(904) 394-8070
NPI assigned
Nov 17, 2006
Last updated
Mar 23, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Authorized official

Name
Mr. Kathleen Patneau, MPH
Title
Administrator
Phone
(904) 394-8056

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 6860320 00 FL Primary

Addresses

Primary practice location

611 E Adams St
Jacksonville, FL 32202-2847

Mailing address

611 E Adams St
Jacksonville, FL 32202-2847
Phone (904) 394-8070

Other identifiers 1

IdentifierTypeStateIssuer
6860320 00MedicaidFL

Other names 1

  • Sulzbacher Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120402000554 FL Part A Provider - Federally Qualified Health Center (FQHC) 2860652641 Practice locations: Jacksonville, FL
O20130815000630 FL Part B Supplier - Clinic/Group Practice 2860652641 Receives reassigned benefits from 31 practitioners
Practice locations: Jacksonville, FL; Jacksonville Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710051354. Details of each certification follow.

Federally qualified health center certification: CCN 101096

Legal name
IM SULZBACHER CENTER FOR THE HOMELESS, INC
Doing business as
THE SULZBACHER CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 9, 1994 in FL
Enrollment address
611 E Adams St
Jacksonville, FL 32202-2847

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0947911Im Sulzbacher Center for the Homeless611 E Adams St, Jacksonville, FL 32202Provider-performed microscopyJul 10, 2027

National Provider Directory

National Provider Directory

Locations

3701 Winton Dr
Jacksonville, FL 32208
Phone (845) 806-6265

850 6th Ave S
Jacksonville Beach, FL 32250
Phone (904) 224-3550

850 6th Ave S
Ste 500
Jacksonville Beach, FL 32250
Phone (904) 224-3550

Networks

  • HealthSun Health Plans Network

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
Cindy Funkhouser Individual Corporate OfficerCeo Aug 1, 2011
W-2 Managing EmployeeCeo Aug 1, 2011
Operational/Managerial ControlCeo Aug 1, 2011
Im Sulzbacher Center for the Homeless, Inc Organization, Jacksonville, FL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 9, 1994
Heather Morris Individual Corporate DirectorAssistant Director, Clinic Operatio Aug 31, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Beaches Community Healthcare' a Sulzabacher ClinicJacksonville Beach, FL, CCN 101116 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 9, 1994

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1710051354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 E ADAMS ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322022847",
            "telephone_number": "904-394-8070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E ADAMS ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322022847",
            "telephone_number": "904-394-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IM SULZBACHER CENTER FOR THE HOMELESS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "PATNEAU",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "904-394-8056",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "FL",
            "license": "6860320 00",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6860320 00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sulzbacher Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.