NPIMap

Organization Active NPI

Jessie Trice Community Health System, Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1831352624
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC
Practice address
1190 NW 95TH St Ste 100
Miami, FL 33150-2064
Phone
(305) 637-6400
Fax
(305) 636-5155
NPI assigned
Jul 2, 2008
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Ryan R Hawkins
Title
President and Ceo
Phone
(305) 637-6400

Specialties & licenses 1

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

Addresses

Primary practice location

1190 NW 95TH St Ste 100
Miami, FL 33150-2064

Mailing address

5607 NW 27TH Ave
Suite 1
Miami, FL 33142-2826
Phone (305) 637-6400

Other identifiers 1

IdentifierTypeStateIssuer
029541802MedicaidFL

Other names 2

  • Jessie Trice Community Health Center, Inc Former legal business name
  • JTCHS Health Center at North Shore Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041020000714 FL Part B Supplier - Clinic/Group Practice 2961486733 Receives reassigned benefits from 59 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Miami, FL; Opa Locka, FL; Miami Gardens, FL; Hialeah, FL
O20041220001091 FL Part A Provider - Federally Qualified Health Center (FQHC) 2961486733 Practice locations: Miami, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831352624. Details of each certification follow.

Federally qualified health center certification: CCN 101965

Legal name
JESSIE TRICE COMMUNITY HEALTH SYSTEM INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 15, 2005
Last certification
Mar 15, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1967 in FL
Enrollment address
1190 NW 95TH St
Ste 100
Miami, FL 33150-2064
Related CCNs
101801

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

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
Ryan Hawkins Individual Corporate DirectorPresident/Ceo Mar 1, 2024
W-2 Managing EmployeeAd; Mar 1, 2024
Irene N Taylor-Wooten Individual Corporate DirectorBoard Member Jan 1, 2012
Pedro Gassant Individual Corporate DirectorBoard of Directors Aug 1, 2023
Paul Roberts Individual Corporate DirectorBoard Member Jan 1, 2012
Tishria L Mindingall Individual Corporate DirectorBoard Member Jan 1, 2012
Lenora Yates Individual Corporate DirectorBoard Member Jan 1, 2012
Angela D Lightfoot Individual Corporate DirectorBoard Member Jan 1, 2012
Carla Jones Individual Corporate DirectorBoard Member Jan 1, 2012
Thamara R Labrousee Individual Corporate DirectorBoard Member Jan 1, 2012
Terrell G West Individual Corporate DirectorBoard Member Jan 1, 2012
Olga Connor Individual Corporate DirectorBoard of Directors Aug 1, 2023
Sherwood G Dubose Individual Corporate DirectorBoard Member Jan 1, 2012
Ivette Klein Individual Corporate DirectorBoard of Directors Jan 1, 2012
David Williams Individual Corporate DirectorBaord Member Jan 1, 2012
Robert L Thomas Individual Corporate DirectorBoard Member Jan 1, 2012

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1831352624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5607 NW 27TH AVE",
            "address_2": "SUITE 1",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331422826",
            "telephone_number": "305-637-6400",
            "fax_number": "305-805-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 NW 95TH ST STE 100",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331502064",
            "telephone_number": "305-637-6400",
            "fax_number": "305-636-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "305-637-6400"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029541802",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jessie Trice Community Health Center, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "JTCHS Health Center at North Shore",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.