NPIMap

Organization Active NPI

Christ Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, TN
National Provider Identifier
1750926549
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES, INC.
Practice address
655 Lexington Ave
Jackson, TN 38301-5075
Phone
(901) 842-3160
Fax
(901) 842-2360
NPI assigned
Nov 15, 2019
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Specialties & licenses 1

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

Addresses

Primary practice location

655 Lexington Ave
Jackson, TN 38301-5075

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 842-3160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20200115002892 TN Part A Provider - Federally Qualified Health Center (FQHC) 3870402084 Practice locations: Jackson, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750926549. Details of each certification follow.

Federally qualified health center certification: CCN 441000

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2020
Last certification
Jan 15, 2020
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
655 Lexington Ave
Jackson, TN 38301-5075

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rebecca Kernan Individual Corporate DirectorBoard Member Jan 1, 2024
John M Drake Individual Corporate OfficerPresident Mar 1, 2026
Corporate DirectorDirector Jan 1, 2024
W-2 Managing EmployeeCeo Mar 1, 2026
Norma L Hunt Individual Corporate DirectorSecretary Jan 1, 2024
Florence Jones Individual Corporate DirectorBoard Member Jan 1, 2024
Jerry Gay Individual Corporate DirectorVice Chair Jan 1, 2024
Reginique Green Individual W-2 Managing EmployeeChief Clinical Officer Jan 5, 2015
Kirk Bailey Individual Corporate DirectorBoard Member Jan 1, 2024
Carol Jackson Individual Corporate DirectorBoard Member Jan 1, 2024
John Ross Dyer Individual Corporate DirectorChair Jan 1, 2024
Carlos Martin Individual Corporate DirectorBoard Member Jan 1, 2024
Kimberly Young Individual Corporate DirectorBoard Member Jan 1, 2024
Angela Rogers Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1573776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1750926549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 UNION AVENUE EXT STE 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124416",
            "telephone_number": "901-842-3160",
            "fax_number": "901-842-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 LEXINGTON AVE",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383015075",
            "telephone_number": "901-842-3160",
            "fax_number": "901-842-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-15",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-842-3160"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.