NPIMap

Organization Active NPI

Peak Vista Community Health Centers

Doing business as Health Center at Academy SUITE 3300

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
National Provider Identifier
1760252001
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
Health Center at Academy SUITE 3300
Practice address
3207 North Academy Blvd
Suite 3300
Colorado Springs, CO 80917
Phone
(719) 632-5700
NPI assigned
Jan 8, 2024
Last updated
Jan 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
PEAK VISTA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Authorized official

Name
Ryan Spillane, CFO
Title
Chief Financial Officer
Phone
(719) 344-7135

Specialties & licenses 1

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

Addresses

Primary practice location

3207 North Academy Blvd
Suite 3300
Colorado Springs, CO 80917

Mailing address

3205 N Academy Blvd Ste 130
Colorado Springs, CO 80917-5152
Phone (719) 632-5700

Other identifiers 1

IdentifierTypeStateIssuer
05638267MedicaidCO

Other names 1

  • Health Center at Academy SUITE 3300 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240228004110 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 Practice locations: Colorado Springs, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760252001. Details of each certification follow.

Federally qualified health center certification: CCN 061067

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT ACADEMY SUITE 3300
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 27, 2024
Last certification
Feb 27, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 8, 2024 in CO
Enrollment address
3207 N Academy Blvd
Suite 3300
Colorado Springs, CO 80917-5100

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Community Health Ctr Co27 organizations share this tax ID, including this one
Part of
Community Health Ctr Co

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
William C Sanden Individual Corporate DirectorBoard Member Jan 1, 2019
Ray Nunn Individual Corporate DirectorBoard Member Oct 1, 2019
Ryan Spillane Individual Corporate OfficerChief Financial Officer Sep 26, 2022
Dennis Smialek Individual Corporate DirectorBoard Member Mar 3, 2020
Santiago R Duran Individual Corporate DirectorBoard Member Sep 6, 2017
Clifton R Turner Individual Corporate DirectorBoard Member Dec 4, 2018
Gertrud M Horvath Individual Corporate DirectorBoard Member Feb 7, 2017
Joel T Tanaka Individual Corporate OfficerChief Medical Officer Oct 11, 2019
Rocio Rodriguez Individual Corporate DirectorBoard Member Sep 1, 2023
Mary M Sheetz Individual Corporate DirectorBoard Member Jan 9, 2018
Leila P Gibson-Green Individual Corporate DirectorBoard Member Dec 1, 2022
Robin E Johnson Individual Corporate DirectorBoard Member Jan 9, 2019
Fadi Youkhana Individual Corporate DirectorBoard Member Jun 1, 2023
Stella U Hodgkins Individual Corporate DirectorBoard Member Nov 1, 2022
Denise Smith Silva Individual W-2 Managing EmployeeBusiness Systems Manager Mar 31, 1987
David Fairley Individual Corporate DirectorBoard Member Jun 1, 2022

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mobile Health Services VanColorado Springs, CO, CCN 061909 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 15, 2012
Logan Health Center at Myron StrattonColorado Springs, CO, CCN 061914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012
Pediatric Health CenterColorado Springs, CO, CCN 061917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1760252001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD STE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175152",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 NORTH ACADEMY BLVD",
            "address_2": "SUITE 3300",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "719-632-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "719-344-7135",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638267",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center at Academy SUITE 3300",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.