NPIMap

Organization Active NPI

Health Partners of Western Ohio

Doing business as Bryan Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bryan, OH
National Provider Identifier
1790020733
Registry record updated Feb 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH PARTNERS OF WESTERN OHIO
Doing business as
Bryan Community Health Center
Practice address
228 S Main St
Bryan, OH 43506-1755
Phone
(419) 785-3827
Fax
(419) 549-5670
NPI assigned
Dec 3, 2012
Last updated
Feb 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2024

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

Authorized official

Name
Janis L. Sunderhaus
Title
Ceo
Phone
(419) 221-3072

Specialties & licenses 1

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

Addresses

Primary practice location

228 S Main St
Bryan, OH 43506-1755

Mailing address

329 N West St
Lima, OH 45801-4332
Phone (419) 221-3072

Other names 1

  • Bryan Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130125000347 OH Part A Provider - Federally Qualified Health Center (FQHC) 9436139987 Practice locations: Bryan, OH
O20150313002043 OH Part B Supplier - Clinic/Group Practice 9436139987 Receives reassigned benefits from 153 practitioners
28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Toledo, OH; Tiffin, OH; New Carlisle, OH; Lima, OH; Bryan, OH; Defiance, OH; Harrod, OH; Holland, OH…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790020733. Details of each certification follow.

Federally qualified health center certification: CCN 361016

Legal name
HEALTH PARTNERS OF WESTERN OHIO
Doing business as
BRYAN COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 25, 2013
Last certification
Jan 25, 2013
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 18, 2002 in OH
Enrollment address
228 S Main St
Bryan, OH 43506-1755

Other NPIs with the same Medicare PAC ID 21

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

View all 21

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Janis Sunderhaus Individual Corporate OfficerChief Executive Officer Jul 1, 2003
W-2 Managing EmployeeChief Executive Officer Jul 1, 2003
Operational/Managerial ControlChief Executive Officer Jul 1, 2003
Angel Cowan Individual OtherBoard Member Nov 1, 2020
Kimberly Taflinger Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial Control Jan 3, 2025
Joseph a. Dake Individual OtherBoard Member Aug 23, 2018
Lorna Simpson Individual OtherBoard Member Jan 28, 2016
Arlisa Hall Individual OtherBoard Member Jul 22, 2010
Anthony Lester Individual OtherBoard Member Oct 27, 2011
John Stanovich Individual OtherBoard Member Jan 28, 2016
Daisy Williamson Individual Other Apr 1, 2024
Rebecca Dershem Individual OtherTreasurer Oct 25, 2002
Mary Williamson Individual OtherVice President Oct 25, 2002
William Stolly Individual OtherPresident Oct 28, 2010

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706832000000",
    "number": "1790020733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 N WEST ST",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458014332",
            "telephone_number": "419-221-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 S MAIN ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061755",
            "telephone_number": "419-785-3827",
            "fax_number": "419-549-5670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH PARTNERS OF WESTERN OHIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-03",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "SUNDERHAUS",
        "authorized_official_first_name": "JANIS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-221-3072"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryan Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bryan Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bryan, OH

Sources for this page

Verify at the official NPI Registry.