NPIMap

Organization Active NPI

Charles Evans Center, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Glen Cove, NY
National Provider Identifier
1770142366
Registry record updated Jun 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CHARLES EVANS CENTER, INC
Practice address
113 Glen Cove Ave
Glen Cove, NY 11542-3438
Phone
(516) 676-2388
Fax
(516) 759-5240
NPI assigned
Jun 7, 2019
Last updated
Jun 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2019

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

Authorized official

Name
Mary Cody
Title
Billing Manager
Phone
(516) 676-2388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

113 Glen Cove Ave
Glen Cove, NY 11542-3438

Mailing address

113 Glen Cove Ave
Glen Cove, NY 11542-3438
Phone (516) 676-2388

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20160427000454 NY Part B Supplier - Clinic/Group Practice 1759695992 Receives reassigned benefits from 66 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glen Cove, NY; Seaford, NY; Bethpage, NY
O20200316001887 NY Part A Provider - Federally Qualified Health Center (FQHC) 1759695992 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glen Cove, NY
O20250611000082 NY Part A Provider - Federally Qualified Health Center (FQHC) 1759695992 1 other NPI on this enrollment
Practice locations: Seaford, NY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1770142366. Details of each certification follow.

Federally qualified health center certification: CCN 571196

Legal name
CHARLES EVANS CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2020
Last certification
Mar 16, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
113 Glen Cove Ave
Glen Cove, NY 11542-3438

Federally qualified health center certification: CCN 571909

Legal name
CHARLES EVANS CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 10, 2025
Last certification
Jun 10, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
2146 Jackson Ave
Seaford, NY 11783-2606

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Charles Evans Center Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
John a. Javis Individual Corporate DirectorExecutive Director Apr 1, 2025 100%
Operational/Managerial ControlExecutive Director Apr 1, 2025 100%
Corporate DirectorExecutive Director Apr 1, 2025
W-2 Managing EmployeeAd; Apr 1, 2025
Diane Peterson Individual Corporate DirectorBoard Member Dec 3, 2019
Anne Emmerson Individual Corporate DirectorBoard Member Dec 3, 2019
Corporate DirectorBoard President Apr 1, 2024
Robert C Goldsmith Individual Corporate DirectorBoard Member Dec 3, 2019
Peter a. Egan Individual Corporate DirectorBoard Member Dec 3, 2019
Corporate DirectorBoard Member Apr 1, 2024
Iris Rosenthal Individual Corporate DirectorBoard Member Dec 3, 2019
Corporate Director Apr 1, 2024
Ronald Tauss Individual Corporate DirectorBoard Member Dec 3, 2019
Corporate Director Apr 1, 2024
Ellen Spiegel Individual Corporate DirectorBoard Member Apr 1, 2024

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559865600000",
    "number": "1770142366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 GLEN COVE AVE",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115423438",
            "telephone_number": "516-676-2388",
            "fax_number": "516-676-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 GLEN COVE AVE",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115423438",
            "telephone_number": "516-676-2388",
            "fax_number": "516-759-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES EVANS CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2019-06-07",
        "status": "A",
        "authorized_official_last_name": "CODY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "516-676-2388"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Cove, NY

Sources for this page

Verify at the official NPI Registry.