NPIMap

Organization Active NPI

Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Meriden, CT
National Provider Identifier
1720263148
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER INC
Practice address
134 State St
Meriden, CT 06450-3293
Phone
(203) 237-2229
Fax
(203) 686-1677
NPI assigned
Jan 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2012

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

Authorized official

Name
Ms. Bain Patrie
Title
Credentialing Specialist
Phone
(860) 347-6971

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 0173 CT
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X 0173 CT
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 0173 CT
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 0173 CT
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

134 State St
Meriden, CT 06450-3293

Mailing address

575 Main St FL 2
Attn: Credentialing DPT
Middletown, CT 06457-2845
Phone (860) 347-6971

Other identifiers 3

IdentifierTypeStateIssuer
004236338MedicaidCT
004236346MedicaidCT
004236354MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080219000147 CT Part A Provider - Federally Qualified Health Center (FQHC) 0547169138 Practice locations: Meriden, CT

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Federally qualified health center certification: CCN 071841

Legal name
COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2008
Last certification
Mar 31, 2008
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 1, 1972 in CT
Enrollment address
134 State St
Meriden, CT 64503293

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Gary Reid Individual Corporate Director Nov 1, 1991
Mark Bonney Individual Corporate Director Nov 1, 1991
Angela Anthony Individual Corporate Director Nov 1, 1991
Mark Masselli Individual 5% Or Greater Direct Ownership InterestPresident/Ceo May 1, 1972 100%
Corporate OfficerPresident/Ceo May 1, 1972 100%
Corporate DirectorPresident/Ceo May 1, 1972 100%
W-2 Managing EmployeePresident/Ceo May 1, 1972 100%
Donald J Case Individual Corporate Director Nov 1, 1991
David Vance Individual Corporate Director Nov 1, 1991
Aida Heredia Individual Corporate Director Nov 1, 1991
Terry Danaher Individual Corporate Director Nov 1, 1991
Maragaret Flinter Individual 5% Or Greater Direct Ownership InterestSVP/Clinical Director Nov 1, 1991 100%
Corporate OfficerSVP/Clinical Director Nov 1, 1991 100%
Corporate DirectorSVP/Clinical Director Nov 1, 1991 100%
W-2 Managing EmployeeSVP/Clinical Director Nov 1, 1991 100%
Stewart R Joslin Individual Corporate Director Nov 1, 1991
W-2 Managing Employee Nov 1, 1991

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Center of DanburyDanbury, CT, CCN 071849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2000
Community Health Center of EnfieldEnfield, CT, CCN 071850 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2000

Owned or controlled facilities with NPI records 2

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

Practitioners 156

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 156

NPI Registry JSON

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1720263148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MAIN ST FL 2",
            "address_2": "ATTN: CREDENTIALING DPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572845",
            "telephone_number": "860-347-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 STATE ST",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064503293",
            "telephone_number": "203-237-2229",
            "fax_number": "203-686-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2012-10-30",
        "status": "A",
        "authorized_official_last_name": "PATRIE",
        "authorized_official_first_name": "BAIN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "860-347-6971",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "0173",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "0173",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "0173",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "0173",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236338",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236354",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

Verify at the official NPI Registry.