NPIMap

Organization Active NPI

Crescent Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Dubuque, IA
National Provider Identifier
1720146319
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CRESCENT COMMUNITY HEALTH CENTER
Practice address
1690 Elm St Ste 300
Dubuque, IA 52001-3679
Phone
(563) 690-0321
Fax
(563) 557-8488
NPI assigned
Dec 5, 2006
Last updated
Jul 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Authorized official

Name
Chad Wolbers
Title
Ceo
Phone
(563) 690-2862

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 08349 IA
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A100692 IA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1690 Elm St Ste 300
Dubuque, IA 52001-3679

Mailing address

1690 Elm St Ste 300
Dubuque, IA 52001-3679
Phone (563) 690-2850

Other names 1

  • Tri State Community Health Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070806000462 IA Part B Supplier - Clinic/Group Practice 0345343158 Receives reassigned benefits from 30 practitioners
Practice locations: Dubuque, IA
O20080219000775 IA Part A Provider - Federally Qualified Health Center (FQHC) 0345343158 Practice locations: Dubuque, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720146319. Details of each certification follow.

Federally qualified health center certification: CCN 161849

Legal name
CRESCENT COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 9, 2008
Last certification
Apr 9, 2008
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 2003 in IA
Enrollment address
1690 Elm St
Ste 300
Dubuque, IA 52001-3679

National Provider Directory

National Provider Directory
Tax ID family
Crescent Community Health Center Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1690 Elm St
Dubuque, IA 52001
Phone (563) 239-9282

1690 Elm St
Ste 300
Dubuque, IA 52001
Phone (563) 690-2850

1789 Elm St
Ste A
Dubuque, IA 52001
Phone (563) 690-2850

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Peter Williams Individual Corporate Director Feb 11, 2008
Mary Corrigan Individual Corporate Director Feb 11, 2008
Nate Zitelman Individual Corporate Director Feb 11, 2008
Gary J Collins Individual Corporate OfficerChief Executive Officer Jun 25, 2019 100%
W-2 Managing EmployeeChief Executive Officer Jun 25, 2019 100%
Brooke Gomez Individual Corporate OfficerChief Operation Officer Aug 22, 2016 100%
W-2 Managing EmployeeChief Operations Officer Oct 19, 2018 100%
Ann Decker Individual Corporate Director Nov 1, 2018
Sue Meade Individual Corporate Director Feb 11, 2008
Deb Hickman Individual Corporate Director Feb 11, 2008
Richard Whitty Individual Corporate Director Feb 11, 2008
Kathy Kessler Individual Corporate Director Nov 1, 2011
Stephanie Martin Individual Corporate Director Nov 1, 2018
Jill Knight Individual Corporate Director Feb 11, 2008
Michael Muench Individual Corporate Director Nov 1, 2016
Brian Schatz Individual Corporate Director Feb 11, 2008
Gary Runde Individual Corporate Director Nov 1, 2018

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1720146319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 ELM ST STE 300",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520013679",
            "telephone_number": "563-690-2850",
            "fax_number": "563-239-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 ELM ST STE 300",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520013679",
            "telephone_number": "563-690-0321",
            "fax_number": "563-557-8488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESCENT COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "WOLBERS",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-690-2862"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IA",
            "license": "08349",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "A100692",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri State Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Tri State Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Dubuque, IA

Sources for this page

Verify at the official NPI Registry.