NPIMap

Organization Active NPI

Moses Lake Community Health Center

Doing business as Quincy Student Health and Wellness Center

  • Student Health Clinic/Center
  • Quincy, WA
National Provider Identifier
1730756644
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
MOSES LAKE COMMUNITY HEALTH CENTER
Doing business as
Quincy Student Health and Wellness Center
Practice address
403 Jackrabbit St NE
Quincy, WA 98848-2008
Phone
(509) 787-8943
NPI assigned
Jun 9, 2021
Last updated
Jun 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MOSES LAKE COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Authorized official

Name
Sheila Berschauer
Title
Ceo
Phone
(509) 766-8971

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Student Health Clinic/Center 261QS1000X Primary

Addresses

Primary practice location

403 Jackrabbit St NE
Quincy, WA 98848-2008

Mailing address

605 Coolidge Drive
Moses Lake, WA 98837
Phone (509) 765-0674

Other identifiers 1

IdentifierTypeStateIssuer
1016722MedicaidWA

Other names 1

  • Quincy Student Health and Wellness Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230206002505 WA Part A Provider - Federally Qualified Health Center (FQHC) 1254235138 Practice locations: Quincy, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730756644. Details of each certification follow.

Federally qualified health center certification: CCN 501017

Legal name
MOSES LAKE COMMUNITY HEALTH CENTER
Doing business as
QUINCY STUDENT HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2023
Last certification
Jan 26, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1996 in WA
Enrollment address
403 Jackrabbit St NE
Quincy, WA 98848-2008

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Quincy Community Health Center12 organizations share this tax ID, including this one
Part of
Quincy Community Health Center

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Amalia Campos Individual Corporate Director Dec 1, 2012
Jose Aguinaga Individual Corporate Director Apr 1, 2018
Sharon Lange Individual Corporate Director Apr 1, 1995
Ladell Yada Individual Corporate Director Jul 1, 2019
Ulises Infante-Miranda Individual Corporate Director Dec 1, 2020
Eva Hidalgo Individual Corporate Director Aug 1, 2014
Dayana Ruiz Individual Corporate Director Aug 1, 2015
Dave Campbell Individual Corporate Director Apr 1, 2016
Sheila Chilson Individual Corporate OfficerCeo Jun 6, 2002
Corporate DirectorCeo Jun 6, 2002
W-2 Managing Employee Jun 6, 2002
Matthew Benson Individual Corporate Director Jun 1, 2011
Michael Homer Individual Corporate Director Apr 1, 2018
Amanda Barta Individual Corporate OfficerCfo May 7, 2007
Corporate Director May 7, 2007
Carol Schimke Individual Corporate Director Jan 1, 2002
Hileal Barrios Individual Corporate Director Mar 1, 2021

Practitioners & affiliated clinicians

Practitioners 234

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 234

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1730756644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 COOLIDGE DRIVE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "98837",
            "telephone_number": "509-765-0674",
            "fax_number": "509-764-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 JACKRABBIT ST NE",
            "city": "QUINCY",
            "state": "WA",
            "postal_code": "988482008",
            "telephone_number": "509-787-8943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES LAKE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOSES LAKE COMMUNITY HEALTH CENTER",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "BERSCHAUER",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "509-766-8971"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016722",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quincy Student Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, WA

Sources for this page

Verify at the official NPI Registry.