NPIMap

Organization Active NPI

Nevada Health Centers, Inc.

Doing business as Eastern Family Medical and Dental Center

  • Federally Qualified Health Center (FQHC)
  • Las Vegas, NV
National Provider Identifier
1780831925
Registry record updated May 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
291837 Issued in NV
Legal business name
NEVADA HEALTH CENTERS, INC.
Doing business as
Eastern Family Medical and Dental Center
Practice address
2212 S Eastern Ave
Las Vegas, NV 89104-4124
Phone
(702) 735-9334
Fax
(702) 735-9335
NPI assigned
Aug 19, 2008
Last updated
May 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2015

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

Authorized official

Name
Walter B Davis
Title
Ceo
Phone
(775) 888-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 291837 NV Primary

Addresses

Primary practice location

2212 S Eastern Ave
Las Vegas, NV 89104-4124

Mailing address

3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610

Other names 1

  • Eastern Family Medical and Dental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20100626000516 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Las Vegas, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780831925. Details of each certification follow.

Federally qualified health center certification: CCN 291837

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
EASTERN FAMILY MEDICAL AND DENTAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
2212 S Eastern Ave
Las Vegas, NV 89104-4124

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory
Tax ID family
Fernley Family Medical34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

2212 S Eastern Ave
Las Vegas, NV 89104
Phone (702) 735-9334

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Paula C Moore Individual Corporate DirectorBoard Member May 1, 2025
Wendy Charlebois Individual Corporate DirectorBoard Member May 1, 2025
Timothy Blakely Individual Corporate DirectorBoard Member Jun 1, 2018
Lyn Beggs Individual Corporate DirectorSecretary Jun 1, 2022
Jeff Snyder Individual Corporate DirectorBoard Member Jun 1, 2016
Tom Zumtobel Individual Corporate DirectorVice Chair Jun 1, 2022
Linda Bingaman Individual Corporate DirectorTreasurer May 15, 2015
Kathryn L Triplett Individual Corporate OfficerCfo Oct 1, 2016 50%
W-2 Managing EmployeeCfo Oct 1, 2016 50%
Nevada Health Centers Inc Organization, Carson City, NV Non-profit Operational/Managerial Control Jun 29, 2010 100%
Maurice Washington Individual Corporate DirectorChairman May 15, 2015
Nicola Aaker Individual Corporate DirectorBoard Member May 1, 2025
Richard Luman Individual Corporate DirectorBoard Member May 1, 2025
Elizabeth Esteves Individual W-2 Managing EmployeeProvider Relations Manager Jun 10, 2024
Lisbeth Soriano Individual Corporate DirectorBoard Member May 1, 2025
Walter B Davis Individual Corporate OfficerCeo Nov 26, 2012 50%
W-2 Managing EmployeeCeo Nov 26, 2012 50%

Owners & managing parties with NPI records 24

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

View all 24

All facility ownership & control disclosures 13

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers Carson City School BasedCarson City, NV, CCN 291854 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 21, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children's Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Willow Street Health CenterReno, NV, CCN 291009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 22, 2023
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

Owned or controlled facilities with NPI records 13

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

View all 13

Facilities with the same owner 13

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

View all 13

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": "1219104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430956800000",
    "number": "1780831925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2212 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891044124",
            "telephone_number": "702-735-9334",
            "fax_number": "702-735-9335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-19",
        "last_updated": "2015-05-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NV",
            "license": "291837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Family Medical and Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.