NPIMap

Organization Active NPI

Escambia Community Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Cantonment, FL
National Provider Identifier
1811344682
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESCAMBIA COMMUNITY CLINICS INC
Practice address
470 S Highway 29 Ste 2
Cantonment, FL 32533
Phone
(850) 780-0111
Fax
(850) 780-0642
NPI assigned
May 20, 2016
Organization subpart
Yes
Parent organization
ESCAMBIA COMMUNITY CLINICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

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

Authorized official

Name
Chandra Smiley
Title
Executive Director
Phone
(850) 436-4630

Specialties & licenses 1

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

Addresses

Primary practice location

470 S Highway 29 Ste 2
Cantonment, FL 32533

Mailing address

2315 W Jackson St
Pensacola, FL 32505-7552
Phone (850) 436-4630

Other identifiers 1

IdentifierTypeStateIssuer
692990721MedicaidFL

Other names 1

  • Cantonment Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161108000022 FL Part A Provider - Federally Qualified Health Center (FQHC) 9638165806 Practice locations: Cantonment, FL

Federally qualified health center certification: CCN 681076

Legal name
ESCAMBIA COMMUNITY CLINICS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 8, 2016
Last certification
Nov 8, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in FL
Enrollment address
470 S Highway 29
Cantonment, FL 32533-8695

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Alan Pendergrass MD15 organizations share this tax ID, including this one
Part of
Alan Pendergrass MD

Other organizations with this tax ID 14

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

View all 14

Locations

470 S Highway 29
Ste 2
Cantonment, FL 32533
Phone (850) 780-0111

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
Grace McCaffery Individual Corporate DirectorBoard Member Jul 29, 2021
Bob Wilson Individual Corporate DirectorBoard Member Sep 1, 2007
Freddie Cattouse Individual Corporate DirectorBoard Member Sep 1, 2007
Shirley Henderson Individual Corporate DirectorBoard Member Dec 31, 2022
Dorothy Foster Individual Corporate Director Apr 1, 2017
Ann Osiname Individual Corporate DirectorBoard Member Sep 1, 2007
Chandra Smiley Individual Corporate OfficerExecutive Director Dec 1, 2014
W-2 Managing EmployeeExecutive Director Dec 1, 2014
Jules Kariher Individual Corporate Officer Jul 1, 2020
Justin H Labrato Individual Corporate Officer Mar 1, 2014
Brett Aldridge Individual Corporate Director Jul 1, 2018
John T Porter Individual Corporate DirectorChairman Sep 1, 2007
Thomas Owens Individual Corporate Director Jul 1, 2018
Sean Seely Individual Corporate Director Apr 1, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Northwest FloridaPensacola, FL, CCN 681048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 29, 1992
Community Health Northwest FloridaPensacola, FL, CCN 681849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1811344682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 S HIGHWAY 29 STE 2",
            "city": "CANTONMENT",
            "state": "FL",
            "postal_code": "32533",
            "telephone_number": "850-780-0111",
            "fax_number": "850-780-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "enumeration_date": "2016-05-20",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-436-4630"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "692990721",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cantonment Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cantonment, FL

Sources for this page

Verify at the official NPI Registry.