NPIMap

Organization Active NPI

Shawnee Mental Health Center, Inc.

Doing business as DBA Shawnee Family Health Center

  • Federally Qualified Health Center (FQHC)
  • West Union, OH
National Provider Identifier
1750851622
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHAWNEE MENTAL HEALTH CENTER, INC.
Doing business as
DBA Shawnee Family Health Center
Practice address
192 Chestnut Ridge Rd
West Union, OH 45693-9584
Phone
(937) 544-5400
Fax
(740) 353-1662
NPI assigned
Dec 4, 2018
Last updated
May 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

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

Authorized official

Name
Cynthia Holstein
Title
Ceo
Phone
(740) 355-8686

Specialties & licenses 1

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

Addresses

Primary practice location

192 Chestnut Ridge Rd
West Union, OH 45693-9584

Mailing address

901 Washington St
Portsmouth, OH 45662-3944
Phone (740) 355-8686

Other identifiers 1

IdentifierTypeStateIssuer
0339258MedicaidOH

Other names 1

  • DBA Shawnee Family Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
RESTful URL shawnee.mental.health.center@clinisync.medicity.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190211000726 OH Part A Provider - Federally Qualified Health Center (FQHC) 7012902075 Practice locations: West Union, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750851622. Details of each certification follow.

Federally qualified health center certification: CCN 361199

Legal name
SHAWNEE MENTAL HEALTH CENTER INC
Doing business as
SHAWNEE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 7, 2019
Last certification
Feb 7, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1973 in OH
Enrollment address
192 Chestnut Ridge Rd
West Union, OH 45693-9584

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Mental Health Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Gary Maddix Individual Corporate Officer Jan 1, 2024
Cynthia Holstein Individual Corporate OfficerCeo May 19, 2013
W-2 Managing EmployeeCeo May 19, 2013
Operational/Managerial Control Jan 4, 2023
Brittany Stanfield-Fegley Individual Corporate Officer Jan 1, 2024
Ashley Endlich Individual W-2 Managing EmployeeAd; Apr 21, 2025
Mary Holsonback Individual W-2 Managing Employee Jan 1, 2025

Practitioners & affiliated clinicians

Practitioners 80

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 80

NPI Registry JSON

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

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1750851622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WASHINGTON ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623944",
            "telephone_number": "740-355-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 CHESTNUT RIDGE RD",
            "city": "WEST UNION",
            "state": "OH",
            "postal_code": "456939584",
            "telephone_number": "937-544-5400",
            "fax_number": "740-353-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-04",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "HOLSTEIN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "740-355-8686"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0339258",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "shawnee.mental.health.center@clinisync.medicity.net",
            "affiliation": "N",
            "address_1": "901 Washington St",
            "city": "Portsmouth",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456623944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "DBA Shawnee Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DBA Shawnee Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Union, OH

Sources for this page

Verify at the official NPI Registry.