NPIMap

Organization Active NPI

Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
National Provider Identifier
1730166034
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEAK VISTA COMMUNITY HEALTH CENTERS
Practice address
3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone
(719) 632-5700
Fax
(719) 344-7865
NPI assigned
Dec 28, 2005
Organization subpart
Yes
Parent organization
PEAK VISTA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Authorized official

Name
Ryan Spillane
Title
Interim Chief Financial Officer
Phone
(719) 344-7135

Specialties & licenses 1

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

Addresses

Primary practice location

3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917

Mailing address

3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone (719) 632-5700

Other identifiers 1

IdentifierTypeStateIssuer
05638267MedicaidCO

Other names 1

  • Community Health Centers, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20030311000013 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO
O20030311000017 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO
O20030311000019 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Divide, CO
O20031110000337 CO Part B Supplier - Clinic/Group Practice 4688583974 Receives reassigned benefits from 406 practitioners
Practice locations: Peyton, CO; Fountian, CO; Divide, CO; Cripple Creek, CO; Colorado Springs, CO
O20041101000565 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO
O20081201000575 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO
O20081201000594 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colorado Springs, CO

Federally qualified health center certification: CCN 061850

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT RIO GRANDE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 22, 1995
Last certification
Dec 22, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
117 W Rio Grande St
Colorado Springs, CO 80903-4013
Related CCNs
061833

Federally qualified health center certification: CCN 061878

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
DEVELOPMENTAL DISABILITIES HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2003
Last certification
Jul 11, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
3205 N Academy Blvd
Ste 120
Colorado Springs, CO 80917-5147
Related CCNs
061833

Federally qualified health center certification: CCN 061879

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT DIVIDE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2003
Last certification
Jul 11, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
34 Hybrook Rd S
Divide, CO 80814-9219
Related CCNs
061833

Federally qualified health center certification: CCN 061833

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT WAHSATCH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
722 S Wahsatch Ave
Colorado Springs, CO 80903-4035

Federally qualified health center certification: CCN 061904

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT MYRON STRATTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 28, 2009
Last certification
Jan 28, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
410 Gold Pass HTS
Colorado Springs, CO 80906-3882

Federally qualified health center certification: CCN 061903

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT UNION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 28, 2009
Last certification
Jan 28, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1971 in CO
Enrollment address
225 S Union Blvd
Ste 1
Colorado Springs, CO 80910-3186

Facilities connected through Provider of Services related, parent or unit certification numbers.

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Peak Vista Community Health Center

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3205 N Academy Blvd
Ste 100
Colorado Springs, CO 80917
Phone (719) 776-3600

1815 Jet Wing Dr
Colorado Springs, CO 80916
Phone (719) 344-6331

34 Hybrook Rd S
Divide, CO 80814
Phone (719) 687-4460

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
William C Sanden Individual Corporate DirectorBoard Member Jan 1, 2019
Ray Nunn Individual Corporate DirectorBoard Member Oct 1, 2019
Dennis Smialek Individual Corporate DirectorBoard Member Mar 3, 2020
Santiago R Duran Individual Corporate DirectorBoard Member Sep 6, 2017
Corporate DirectorBoard Member Jul 1, 2010
Clifton R Turner Individual Corporate DirectorBoard Member Dec 4, 2018
Gertrud M Horvath Individual Corporate DirectorBoard Member Feb 7, 2017
Corporate OfficerBoard Member Feb 7, 2017
Joel T Tanaka Individual Corporate OfficerSenior VP of Medical Services Oct 11, 2019
Mary M Sheetz Individual Corporate DirectorBoard Member Jan 9, 2018
Michael D Welch Individual Corporate OfficerVice President of Medical and de Aug 18, 2003
Corporate OfficerVice President of Medical and de Sep 9, 2011
Corporate OfficerVP of Medical and Dental Aug 18, 2003
Corporate OfficerVP of Medical and Dental Aug 18, 2013
Corporate OfficerVP of Medical and Dental Sep 9, 2011
Rodrigo Villazon Individual Corporate DirectorBoard Member Sep 6, 2017
Robin E Johnson Individual Corporate DirectorBoard Member Jan 9, 2018
Denise Smith Silva Individual W-2 Managing EmployeeBusiness Systems Manager Mar 31, 1987
Pamela Ann Taylor Individual Corporate DirectorBoard Member Feb 1, 2019
Victoria R Stone Individual Corporate DirectorBoard Member Jun 1, 2012
Ryan Spillane Individual Corporate OfficerChief Financial Officer Sep 26, 2022
John Eastman Individual Corporate DirectorBoard Member Jan 18, 2024
Rocio Rodriguez Individual Corporate DirectorBoard Member Sep 1, 2023
Leila P Gibson-Green Individual Corporate DirectorBoard Member Dec 1, 2022
Fadi Youkhana Individual Corporate DirectorBoard Member Jun 1, 2023
Stella U Hodgkins Individual Corporate DirectorBoard Member Nov 1, 2022
David Fairley Individual Corporate DirectorBoard Member Jun 1, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mobile Health Services VanColorado Springs, CO, CCN 061909 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 15, 2012
Logan Health Center at Myron StrattonColorado Springs, CO, CCN 061914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012
Pediatric Health CenterColorado Springs, CO, CCN 061917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 419

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

View all 419

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1730166034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2005-12-28",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "INTERIM CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "719-344-7135"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638267",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Centers, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Community Health Centers, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.