People's Community Clinic, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PEOPLE'S COMMUNITY CLINIC, INC.

Doing business as

People's Community Clinic Off-Site Clinic at Austin Children's Shelter

Practice address

4800 Manor Rd
Austin, TX 78723-5471

Phone

(512) 478-4939

Fax

(512) 320-0702

NPI assigned

Jul 9, 2012

Last updated

Nov 19, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Regina Rogoff

Title

Chief Executive Officer

Phone

(512) 478-4939

Specialties & licenses 1

Addresses

Other names 1

• People's Community Clinic Off-Site Clinic at Austin Children's Shelter Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710242441. Details of each certification follow.

• CCN 741804 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 741804

Legal name

PEOPLE'S COMM CL OFF-SITE CL AT AUSTIN CHILDREN'S

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 5, 2012

Last certification

Sep 5, 2012

Ownership / control type

For profit – corporation

Facility address

4800 Manor Rd
Austin, TX 78723

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1710242441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 CAMINO LA COSTA",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787523930",
            "telephone_number": "512-478-4939",
            "fax_number": "512-320-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 MANOR RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787235471",
            "telephone_number": "512-478-4939",
            "fax_number": "512-320-0702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLE'S COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "ROGOFF",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "512-478-4939"
    },
    "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": "People's Community Clinic Off-Site Clinic at Austin Children's Shelter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "People's Community Clinic Off-Site Clinic at Austin Children's Shelter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vishnu Sravya Penubarthi
• Valeria Penunuri
• Cynthia Penwell, LCSW
• People's Community Clinic, Inc.
• People's Community Clinic, Inc. (People's Community Clinic)
• People's Community Clinic, Inc. (People's Community Pharmacy)
• People's Wellness Center
• Peoples Community Clinic Inc
• Peoples Pharmacy
• Peoples Pharmacy

• Federally Qualified Health Center (FQHC) in Austin, TX
• Providers in Austin, TX by specialty
• Federally Qualified Health Center (FQHC) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.