NPIMap

Organization Active NPI

Family Health Services of Darke County, Inc.

  • Federally Qualified Health Center (FQHC)
  • Arcanum, OH
National Provider Identifier
1821325499
Registry record updated Nov 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Practice address
702 N Main St
Arcanum, OH 45304-1426
Phone
(937) 692-6601
Fax
(937) 692-6572
NPI assigned
Nov 3, 2009
Last updated
Nov 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2009

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

Authorized official

Name
Jean E Young
Title
Executive Director
Phone
(937) 548-9680

Specialties & licenses 1

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

Addresses

Primary practice location

702 N Main St
Arcanum, OH 45304-1426

Mailing address

5735 Meeker Rd
Greenville, OH 45331-1180
Phone (937) 548-9680

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110228000767 OH Part A Provider - Federally Qualified Health Center (FQHC) 5698762235 Practice locations: Arcanum, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821325499. Details of each certification follow.

Federally qualified health center certification: CCN 361903

Legal name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Doing business as
FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 8, 2005
Last certification
Sep 8, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1973 in OH
Enrollment address
702 N Main St
Arcanum, OH 45304-1421
Related CCNs
361840

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Family HLTH SVCS33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

5735 Meeker Rd
Ste 4
Greenville, OH 45331

5735 Meeker Rd
Ste 5
Greenville, OH 45331

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
Crysta Bloomingdale Individual Corporate DirectorBoard Member Jul 30, 2018
Austie M Auker Individual W-2 Managing EmployeeCfo Jun 25, 2012 100%
Alan Ayette Individual Corporate DirectorBoard Member Jul 10, 2023
Michael Robert Maher Individual Corporate DirectorBoard Member Oct 20, 2009
Sonja Etzell Individual Corporate DirectorBoard Member Jul 27, 2015
Joy Greer Individual Corporate DirectorBoard Member Aug 5, 2019
Cassidy Helman Individual Corporate DirectorBoard Member Aug 1, 2022
Kathy S O'Dell Individual Corporate DirectorBoard Member Oct 20, 2009
Jared M Pollick Individual Corporate OfficerCeo May 22, 2020 100%
W-2 Managing EmployeeCeo May 22, 2020 100%
John Warner Individual Corporate OfficerBoard Member Aug 1, 2022
Thomas Treon Individual Corporate DirectorBoard Member Jul 30, 2018
Scott C Clum Individual Corporate DirectorBoard Member Oct 20, 2009

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
Comprehensive Health NetworkGreenville, OH, CCN 367444 Home health agency 5% Or Greater Direct Ownership Interest May 19, 2009

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257206400000",
    "number": "1821325499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 MEEKER RD",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453311180",
            "telephone_number": "937-548-9680",
            "fax_number": "937-548-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 N MAIN ST",
            "city": "ARCANUM",
            "state": "OH",
            "postal_code": "453041426",
            "telephone_number": "937-692-6601",
            "fax_number": "937-692-6572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2009-11-03",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "937-548-9680"
    },
    "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 Arcanum, OH

Sources for this page

Verify at the official NPI Registry.