NPIMap

Organization Active NPI

Five Rivers Health Centers

  • Federally Qualified Health Center (FQHC)
  • Xenia, OH
National Provider Identifier
1801331384
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FIVE RIVERS HEALTH CENTERS
Practice address
360 Wilson Dr
Xenia, OH 45385-1810
Phone
(937) 208-3535
NPI assigned
Dec 20, 2016
Last updated
Feb 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Gina McFarlane-El
Title
Ceo
Phone
(937) 281-6800

Specialties & licenses 1

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

Addresses

Primary practice location

360 Wilson Dr
Xenia, OH 45385-1810

Mailing address

721 Miami Chapel Rd
Dayton, OH 45417-4650
Phone (937) 281-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170524002475 OH Part A Provider - Federally Qualified Health Center (FQHC) 9335300904 Practice locations: Xenia, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801331384. Details of each certification follow.

Federally qualified health center certification: CCN 361134

Legal name
FIVE RIVERS HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2017
Last certification
May 17, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 2011 in OH
Enrollment address
360 Wilson Dr
Xenia, OH 45385-1870

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Five Rivers Health Centers19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Mamle Anim Individual Corporate OfficerChief Medical Officer May 23, 2011
Brenda Jean Roman Individual OtherBoard Member Apr 13, 2016
Diane Welborn Individual OtherBoard Member Apr 1, 2012
Resta Zeremariam Individual OtherBoard Member Jan 1, 2023
Dwight Brown Individual OtherBoard Member Apr 1, 2012
Lynn Foubert Individual OtherBoard Member Jul 13, 2023
Jo Bouchard Individual OtherBoard Member May 11, 2017
Richard Goshay Individual OtherBoard Member Apr 1, 2012
Tara Roesch Individual W-2 Managing EmployeeCfo Nov 1, 2018
Gina M McFarlane-El Individual W-2 Managing EmployeeChief Executive Officer May 23, 2011
Operational/Managerial ControlCeo May 23, 2011 100%
Dawn Walker Individual OtherBoard Member Jun 12, 2018
Jennifer Wentzel Individual OtherBoard Member Jan 1, 2023
Amy Wiedeman Individual OtherBoard Member Apr 1, 2012

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Five Rivers Health CentersDayton, OH, CCN 361007 Federally qualified health center Operational/Managerial Control (100%) May 23, 2011

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1482192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1801331384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174650",
            "telephone_number": "937-281-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 WILSON DR",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453851810",
            "telephone_number": "937-208-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE RIVERS HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-20",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "MCFARLANE-EL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-281-6800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Xenia, OH

Sources for this page

Verify at the official NPI Registry.