NPIMap

Organization Active NPI

Community Clinical Services, Inc.

Doing business as CCS Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Lewiston, ME
National Provider Identifier
1740649227
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY CLINICAL SERVICES, INC.
Doing business as
CCS Pediatrics
Practice address
330 Sabattus St
Suite B
Lewiston, ME 04240-5553
Phone
(207) 755-3160
Fax
(207) 755-3166
NPI assigned
Feb 12, 2016
Last updated
Oct 22, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY CLINICAL SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Authorized official

Name
Coleen L Elias
Title
Ceo/Cfo
Phone
(207) 513-3897

Specialties & licenses 1

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

Addresses

Primary practice location

330 Sabattus St
Suite B
Lewiston, ME 04240-5553

Mailing address

PO Box 95000 LBX 7660
Philadelphia, PA 19195-0001
Phone (207) 777-8202

Other names 1

  • CCS Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160304001312 ME Part A Provider - Federally Qualified Health Center (FQHC) 0042101099 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lewiston, ME

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740649227. Details of each certification follow.

Federally qualified health center certification: CCN 201920

Legal name
COMMUNITY CLINICAL SERVICES INC
Doing business as
CCS PEDIATRICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 24, 2016
Last certification
Mar 24, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Sep 19, 1985 in ME
Enrollment address
330 Sabattus St Ste B
Lewiston, ME 42405553

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Community Clinical Services Inc23 organizations share this tax ID, including this one
Part of
Community Clinical Services Inc

Other organizations with this tax ID 22

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

View all 22

Locations

330 Sabattus St
Ste B
Lewiston, ME 04240
Phone (207) 755-3160

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
Frances a Rodgers Individual Corporate Director May 24, 2021 11.11%
Coleen L Elias Individual Corporate OfficerCeo Mar 11, 2020
W-2 Managing EmployeeCeo Mar 11, 2020
Operational/Managerial ControlCeo Mar 11, 2020
Elizabeth a Keene Individual Corporate Director Jan 22, 2015 11.11%
Paige a Hagerstrom Individual Corporate Director May 23, 2016 11.11%
Hawo a Abdille Individual Corporate OfficerVice Chair Jun 28, 2021 11.11%
Corporate DirectorVice Chair May 1, 2020 11.11%
Abdi Abdalla Individual Corporate Director Apr 25, 2022 11.11%
Lynn Ward Individual Corporate OfficerChairperson Jun 30, 2020 11.11%
Corporate DirectorChairperson Sep 24, 2018 11.11%
Andrew Lunn Individual Corporate OfficerSecretary Jan 23, 2023 11.11%
Corporate DirectorSecretary Jan 23, 2023 11.11%
Laura L Minkowsky-Gormley Individual Corporate OfficerTreasurer Jun 30, 2020 11.11%
Corporate DirectorTreasurer Jun 25, 2018 11.11%
Abdulkerim M Said Individual Corporate Director Nov 16, 2020 11.11%

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1740649227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000 LBX 7660",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191950001",
            "telephone_number": "207-777-8202",
            "fax_number": "207-783-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 SABATTUS ST",
            "address_2": "SUITE B",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042405553",
            "telephone_number": "207-755-3160",
            "fax_number": "207-755-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CLINICAL SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY CLINICAL SERVICES, INC.",
        "enumeration_date": "2016-02-12",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "ELIAS",
        "authorized_official_first_name": "COLEEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/CFO",
        "authorized_official_telephone_number": "207-513-3897"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCS Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCS Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewiston, ME

Sources for this page

Verify at the official NPI Registry.