NPIMap

Organization Active NPI

Cincinnati Health Network, Inc

  • Federally Qualified Health Center (FQHC)
  • Cincinnati, OH
National Provider Identifier
1750655478
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CINCINNATI HEALTH NETWORK, INC
Practice address
40 E McMicken Ave
Cincinnati, OH 45202-6549
Phone
(513) 961-0600
Fax
(513) 961-0643
NPI assigned
Feb 27, 2012
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Austin Maddox, CPA
Title
Cfo
Phone
(513) 961-0600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

40 E McMicken Ave
Cincinnati, OH 45202-6549

Mailing address

40 E McMicken Ave Ste 3
Cincinnati, OH 45202-6626
Phone (513) 961-0600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121119000431 OH Part A Provider - Federally Qualified Health Center (FQHC) 2062678758 Practice locations: Cincinnati, OH

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1750655478. Details of each certification follow.

Federally qualified health center certification: CCN 361014

Legal name
CINCINNATI HEALTH NETWORK, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2012
Last certification
Nov 19, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 1986 in OH
Enrollment address
40 E McMicken Ave
Ste 2
Cincinnati, OH 45202-6626

Federally qualified health center certification: CCN 361008

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CINCINNATI HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 19, 2012
Last certification
Nov 19, 2012
Ownership / control type
For profit – corporation
Facility address
40 East McMicken Avenue
Cincinnati, OH 45202

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Locations

2825 Burnet Ave
Ste 232
Cincinnati, OH 45219
Phone (513) 281-1114

411 Gest St
Cincinnati, OH 45203

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Mona Jenkins Individual Corporate DirectorBoard Member Oct 1, 2017
Mathew Jackson Individual Corporate DirectorBoard Member Oct 1, 2009
Cincinnati Health Network, Inc Organization, Cincinnati, OH Non-profit 5% Or Greater Direct Ownership Interest Sep 5, 1986 100%
Valorie Costello Individual Corporate DirectorBoard Member Feb 1, 2016
Sandra Driggins-Smith Individual Corporate DirectorBoard Member May 1, 2018
Jerry Bedford Individual Corporate DirectorBoard Vice Chair Oct 1, 2006
Kelly Dunnigan Individual Corporate DirectorBoard Member Jun 1, 2016
Brian Vanderhorst Individual W-2 Managing EmployeeCoo Jan 1, 2016
Toni Winston Individual Corporate DirectorBoard Chair Oct 1, 2014
John Cobey Individual Corporate DirectorBoard Member Feb 1, 2017
Taylor Jenkins Individual Corporate DirectorBoard Member Oct 1, 2014
Kathleen M Wilson Individual Corporate OfficerCeo Dec 1, 2003 100%
Operational/Managerial ControlCeo Dec 1, 2003 100%
Ronald Hector Individual Corporate DirectorBoard Member Oct 1, 2010

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
ShelterhouseCincinnati, OH, CCN 361109 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 5, 1986

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1750655478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E MCMICKEN AVE STE 3",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452026626",
            "telephone_number": "513-961-0600",
            "fax_number": "513-961-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 E MCMICKEN AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452026549",
            "telephone_number": "513-961-0600",
            "fax_number": "513-961-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCINNATI HEALTH NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-961-0600",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.