NPIMap

Organization Active NPI

Third Street Community Clinic Inc

Doing business as Shelby Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Shelby, OH
National Provider Identifier
1811364706
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC INC
Doing business as
Shelby Health and Wellness Center
Practice address
31 E Main St
Shelby, OH 44875-1262
Phone
(419) 525-6795
NPI assigned
Aug 26, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

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

Addresses

Primary practice location

31 E Main St
Shelby, OH 44875-1262

Mailing address

1404 Park Ave W
Ste 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other names 1

  • Shelby Health and Wellness 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
O20160226000625 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Shelby, OH
O20160506000486 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 18 practitioners
Practice locations: Shelby, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811364706. Details of each certification follow.

Federally qualified health center certification: CCN 361103

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
SHELBY HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2016
Last certification
Mar 1, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
31 E Main St
Shelby, OH 44875-1262

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Locations

270 Sterkel Blvd
Ste A
Mansfield, OH 44907
Phone (419) 526-7866

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate OfficerCfo Jul 28, 2021
W-2 Managing EmployeeCfo Jul 28, 2021
James Dolan Individual Corporate DirectorBoard Member Jul 28, 2021
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 28, 2021
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Joe Stafford Individual Corporate DirectorBoard Member Oct 19, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Cindy Wetterau Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 28, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Tom Walker Individual Corporate DirectorBoard Member Oct 19, 2023
Amber Wertman Individual Corporate DirectorBoard Member Jul 28, 2021
Cody Albert Individual Corporate DirectorBoard Member Jul 28, 2021
Peggy S Anderson Individual Corporate OfficerCeo Jul 28, 2021
Corporate DirectorBoard Member - P Jul 28, 2021
W-2 Managing EmployeeCeo Jul 28, 2021
Joe Devany Individual Corporate DirectorBoard Member Oct 19, 2023
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Jul 28, 2021
Corporate Director Jul 28, 2021
W-2 Managing EmployeeCoo Jul 28, 2021
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1811364706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "STE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 E MAIN ST",
            "city": "SHELBY",
            "state": "OH",
            "postal_code": "448751262",
            "telephone_number": "419-525-6795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "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": "Shelby Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shelby Health and Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, OH

Sources for this page

Verify at the official NPI Registry.