Peak Vista Community Health Centers
Organization Active NPI Federally Qualified Health Center (FQHC) · Colorado Springs, CO
NPI 1780988246 · NPPES record last updated May 19, 2021
Key facts
- NPI
- 1780988246
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PEAK VISTA COMMUNITY HEALTH CENTERS
- Practice address
- 350 Printers Pkwy
Colorado Springs, CO 80910 - Phone
- (719) 632-5700
- Fax
- (719) 344-7863
- NPI assigned
- Dec 27, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- PEAK VISTA COMMUNITY HEALTH CENTERS
Authorized official
- Name
- Cindy Pratt
- Title
- Chief Financial Officers
- Phone
- (719) 344-6188
Owners & managing parties with NPI records 1
-
Pamela Ann Taylor, M.D.
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 23
Corporate family (same tax ID) 26
Related certifications (CCN) 2
Practitioners 126
-
Sally Abell, DNP
-
Elizabeth A Anderson, FNP-BC
-
Marshal Earl Ash, DO
-
Ellis Beardsley, DO
-
Ned O Becker, MS LPC
-
Katie Bennion, PA-C
-
Timothy L Bewley, PAC
-
Neida L. Blondet, MSN, APRN, FNP-C
-
Patricia D Bursnall, FNP-C
-
Sarah Jean Christensen, FNP-BC
-
Amy Dille Clauss, MD
-
Linda Corum, LPC
-
Amy Deitemeyer, PA-C
-
Ee-Leng Dejesus, DO
-
Jeffrey David Derry, LPC
-
Cory Lynn Dietz, MD
-
Molly Dinnen, FNP, AGACNP
-
Amy G Dowling, CRNP
-
Katherine Duggleby, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Federally qualified health center certification: CCN 061877
- Legal name
- PEAK VISTA COMMUNITY HEALTH CENTERS
- Doing business as
- HEALTH CENTER AT 350 PRINTERS PARKWAY
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 11, 2003
- Last certification
- Jul 11, 2003
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 24, 1971 in CO
- Enrollment address
- 350 Printers Pkwy
Colorado Springs, CO 80910-3190 - Related CCNs
- 061833
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| William C Sanden |
Corporate Director |
Jan 1, 2019 | |
| Ray Nunn |
Corporate Director |
Oct 1, 2019 | |
| Ryan Spillane |
Corporate Officer |
Sep 26, 2022 | |
| Dennis Smialek |
Corporate Director |
Mar 3, 2020 | |
| Santiago R Duran |
Corporate Director |
Sep 6, 2017 | |
| Clifton R Turner |
Corporate Director |
Dec 4, 2018 | |
| Gertrud M Horvath |
Corporate Director |
Feb 7, 2017 | |
| Mary M Sheetz |
Corporate Director |
Jan 9, 2018 | |
| Michael D Welch |
Corporate Officer |
Sep 9, 2011 | |
| Rodrigo Villazon |
Corporate Director |
Sep 6, 2017 | |
| Robin E Johnson |
Corporate Director |
Jan 9, 2018 | |
| Denise Smith Silva |
W-2 Managing Employee |
Mar 31, 1987 | |
| Pamela Ann Taylor |
Corporate Director |
Feb 1, 2019 | |
| Victoria R Stone |
Corporate Director |
Jan 1, 2017 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Mobile Health Services Van |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Mar 15, 2012 |
| Logan Health Center at Myron Stratton |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 5, 2012 |
| Pediatric Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 5, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030311000014 | CO | Part a Provider - Federally Qualified Health Center (FQHC) | 4688583974 | Practice locations: Colorado Springs, CO |
National Provider Directory
- Tax ID family
- Peak Vista Community Health Center
- Part of
- Peak Vista Community Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | CO | Yes |
Addresses
Primary practice location
350 Printers Pkwy
Colorado Springs, CO 80910
Mailing address
3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone (719) 632-5700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05638267 | Other | MEDICAID GROUP | |
| 05638267 | Medicaid | CO | |
| 23807377 | Medicaid | CO |
Other names
- Health Center at 350 Printers Parkway
Other providers in Colorado Springs, CO
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers
All providers in Colorado Springs, CO · Federally Qualified Health Center (FQHC) in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.