NPIMap

Organization Active NPI

Chase Brexton Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Easton, MD
National Provider Identifier
1801920939
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHASE BREXTON HEALTH SERVICES, INC.
Practice address
500 Cadmus LN Ste 203
Easton, MD 21601-4094
Phone
(410) 837-2020
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Mr. Kyle Easton
Title
Revenue Cycle Director
Phone
(410) 837-2050

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MD
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Health Service Clinic/Center 261QH0100X

Addresses

Primary practice location

500 Cadmus LN Ste 203
Easton, MD 21601-4094

Mailing address

1111 North Charles Street
Baltimore, MD 21201
Phone (410) 837-2050

Other identifiers 1

IdentifierTypeStateIssuer
132190100MedicaidMD

Other names 1

  • Chase Brexton Health Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070410000352 MD Part A Provider - Federally Qualified Health Center (FQHC) 5395644835 Practice locations: Easton, MD

Federally qualified health center certification: CCN 211864

Legal name
CHASE BREXTON HEALTH SERVICES INC
Doing business as
CHASE BREXTON HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 21, 2007
Last certification
May 21, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1989 in MD
Enrollment address
500 Cadmus LN
Ste 203
Easton, MD 21601-4094

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Chase Brexton Health Care20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

500 Cadmus Ln
Ste 203
Easton, MD 21601
Phone (410) 837-2020

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
Juan Negrin Individual Corporate DirectorBoard of Directors Jan 1, 2017 5%
Alaysia Phillips Individual Corporate DirectorBoard of Directors Jan 1, 2021 5%
Kyle Easton Individual Corporate DirectorRevenue Cycle Director Jun 1, 2016 5%
Joe Ferlise Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Patrick Mutch Individual Contracted Managing EmployeeCeo Mar 1, 2017 50%
Corporate OfficerCeo Mar 1, 2017 50%
Russell Montgomery Individual Corporate DirectorBoard of Directors Jan 1, 2022 5%
Rahul Gor Individual Corporate DirectorBoard of Directors Jan 1, 2017 5%
Oscar Franklin Individual Corporate DirectorBoard of Directors Jan 1, 2022 5%
Kaye Gooche Individual Corporate DirectorBoard of Directors Jan 1, 2022 5%
Samuel Fuller Individual Corporate DirectorBoard of Directors Jan 1, 2015
Julia Krieger Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Falayrium Burden Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Damian Crawford Individual Corporate DirectorBoard of Directors Jan 1, 2016 5%
Eric Richard Turnbaugh Individual Corporate OfficerCfo Sep 16, 2019 25%
Jessica Obyan Individual Corporate DirectorBoard of Directors Jan 1, 2022 5%

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1801920939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 NORTH CHARLES STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "410-837-2050",
            "fax_number": "410-752-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 CADMUS LN STE 203",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216014094",
            "telephone_number": "410-837-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASE BREXTON HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "410-837-2050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MD",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132190100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Easton, MD

Sources for this page

Verify at the official NPI Registry.