NPIMap

Organization Active NPI

Chase Brexton Health Services, Inc.

Doing business as Chase Brexton Health Care

  • Federally Qualified Health Center (FQHC)
  • Columbia, MD
National Provider Identifier
1821336959
Registry record updated Mar 5, 2025
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.
Doing business as
Chase Brexton Health Care
Practice address
9030 State Route 108 Ste a
Columbia, MD 21045-1990
Phone
(410) 837-2050
NPI assigned
Jan 24, 2013
Last updated
Mar 5, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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 NU Primary
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

9030 State Route 108 Ste a
Columbia, MD 21045-1990

Mailing address

1111 N Charles St
Baltimore, MD 21201-5505
Phone (410) 837-2050

Other practice location 1

5500 Knoll North Drive
Suite 370
Columbia, MD 21045-2393
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
O20131109000016 MD Part A Provider - Federally Qualified Health Center (FQHC) 5395644835 Practice locations: Columbia, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821336959. Details of each certification follow.

Federally qualified health center certification: CCN 211893

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
Nov 9, 2013
Last certification
Nov 9, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1989 in MD
Enrollment address
9030 State Route 108
Ste a
Columbia, MD 21045-1990

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

9030 State Route 108
Ste A
Columbia, MD 21045
Phone (410) 740-1901

Ownership & related parties

All disclosed owners & managing parties 9

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, 2019 5%
Kyle Easton Individual Corporate DirectorRevenue Cycle Director Jun 1, 2016 5%
Patrick Mutch Individual 5% Or Greater Indirect Ownership InterestCeo Mar 1, 2017 100%
Corporate OfficerCeo Mar 1, 2017 100%
Operational/Managerial ControlCeo Feb 1, 2017 100%
OtherCeo Feb 1, 2017 50%
Rahul Gor Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Kaye Gooche Individual OtherBoard President Jan 1, 2024 5%
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, 2019 5%
Eric Richard Turnbaugh Individual Corporate OfficerCfo Sep 16, 2019 25%

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": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1821336959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212015505",
            "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": "9030 STATE ROUTE 108 STE A",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451990",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5500 Knoll North Drive",
            "address_2": "Suite 370",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210452393",
            "country_code": "US",
            "telephone_number": "410-837-2050",
            "fax_number": "410-715-3734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHASE BREXTON HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-24",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "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"
        }
    ]
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.