NPIMap

Organization Active NPI

District Clinic Holdings Inc

  • Federally Qualified Health Center (FQHC)
  • West Palm Beach, FL
National Provider Identifier
1780155200
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DISTRICT CLINIC HOLDINGS INC
Practice address
2051 45TH St Ste 300
West Palm Beach, FL 33407-2031
Phone
(561) 642-1000
NPI assigned
Dec 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Darcy Davis
Title
Ceo
Phone
(561) 804-5885

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

2051 45TH St Ste 300
West Palm Beach, FL 33407-2031

Mailing address

1515 N Flagler Dr Ste 101
West Palm Beach, FL 33401-3429
Phone (561) 642-1000

Other names 1

  • CL Brumback Primary Care Clinic, Mangonia Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191030003723 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486876000 Practice locations: West Palm Beach, FL
O20260527002294 FL Part B Supplier - Clinic/Group Practice 4486876000 Receives reassigned benefits from 25 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Palm Beach, FL; Delray Beach, FL; Jupiter, FL; Boca Raton, FL; Belle Glade, FL; Palm Springs, FL

Federally qualified health center certification: CCN 681160

Legal name
DISTRICT CLINIC HOLDINGS INC
Doing business as
CL BRUMBACK PRIMARY CARE CLINIC MANGONIA PARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2019
Last certification
Oct 30, 2019
Ownership / control type
For profit – partnership
Organization structure
GovernmentNon-profit
Incorporated
Jul 31, 2012 in FL
Enrollment address
2051 45TH St
Ste 300
West Palm Beach, FL 33407-2031

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
District Clinic Holdings Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

2151 45th St
Ste 102
West Palm Beach, FL 33407
Phone (407) 842-4322

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Candice R Abbott Individual Corporate OfficerChief Operations Officer Feb 1, 2021
Operational/Managerial ControlChief Financial Officer Feb 1, 2021
District Clinic Holdings Inc Organization, West Palm Beach, FL Non-profit 5% Or Greater Direct Ownership Interest Oct 15, 2019 100%
Operational/Managerial Control Oct 15, 2019 100%
Darcy Davis Individual Corporate OfficerCeo Mar 6, 2016

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
CL Brumback Primary Care Clinic, LantanaLantana, FL, CCN 101184 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, DelrayDelray Beach, FL, CCN 101190 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic Belle GladeBelle Glade, FL, CCN 101189 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, West Palm BeachWest Palm Beach, FL, CCN 101194 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, Lewis CenterWest Palm Beach, FL, CCN 681017 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinics, Lake WorthLake Worth, FL, CCN 681059 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 28, 2015
Jul 28, 2015
CL Brumback Primary Care Clinic, Boca RatonBoca Raton, FL, CCN 681087 Federally qualified health center Operational/Managerial Control Apr 10, 2017
District Clinic Holdings IncJupiter, FL, CCN 681088 Federally qualified health center Operational/Managerial Control Mar 6, 2017
Health Care District Community Health CenterPalm Springs, FL, CCN C11056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 12, 2025

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 9

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

NPI Registry JSON

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1780155200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N FLAGLER DR STE 101",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334013429",
            "telephone_number": "561-642-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 45TH ST STE 300",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072031",
            "telephone_number": "561-642-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT CLINIC HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-10",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DARCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-804-5885"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CL Brumback Primary Care Clinic, Mangonia Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CL Brumback Primary Care Clinic, Mangonia Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.