NPIMap

Organization Active NPI

Community Health Center of Lubbock, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lubbock, TX
National Provider Identifier
1831569540
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Practice address
3502 9TH St Ste 280
Lubbock, TX 79415
Phone
(806) 791-5537
NPI assigned
Oct 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Michael Sullivan
Title
Ceo
Phone
(806) 765-2611

Specialties & licenses 1

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

Addresses

Primary practice location

3502 9TH St Ste 280
Lubbock, TX 79415

Mailing address

1610 5TH St
Lubbock, TX 79401-2622
Phone (806) 765-2611

Other identifiers 2

IdentifierTypeStateIssuer
741928OtherTXMEDICARE A
362609501MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160607000395 TX Part A Provider - Federally Qualified Health Center (FQHC) 6002710860 Practice locations: Lubbock, TX
O20180731002269 TX Part B Supplier - Clinic/Group Practice 6002710860 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
Practice locations: Lubbock, TX

Federally qualified health center certification: CCN 741928

Legal name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Doing business as
CHCL MEDICAL PLAZA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2016
Last certification
Jun 7, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1992 in TX
Enrollment address
3502 9TH Street
Suite 280
Lubbock, TX 79415-5305

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2124458Community Health Center of Lubbock, Inc3502 9TH Street, Ste 280, Lubbock, TX 79415Provider-performed microscopyJan 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

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
Michael P Sullivan Individual Corporate OfficerChief Executive Officer Jul 1, 1998 100%
D. Melynn Henry Individual Corporate DirectorBoard Member Mar 15, 2016
Brandon Hartley Individual Corporate DirectorBoard Member Mar 15, 2016
Aaron S. Davis Individual Corporate DirectorBoard Member May 21, 2019
Elizabeth Lopez Individual W-2 Managing EmployeeChief Development Officer/Deputy Oct 1, 2015
James a Johnson Individual Corporate DirectorTreasurer Dec 21, 2010
Bertha Martinez Individual Corporate DirectorBoard Member Feb 15, 2005
Barbra C Moore Individual Corporate DirectorFinance Director Dec 22, 2015
W-2 Managing EmployeeFinance Director Oct 16, 2015
Margaret J Gaines Individual Corporate DirectorBoard Member Dec 16, 2008
Patricia a Mora Individual Corporate DirectorBoard Member Aug 10, 2003
Allan C Camacho Individual Corporate DirectorMedical Director Feb 28, 2017
W-2 Managing EmployeeMedical Director Jul 28, 2012 90%
Gilbert Michael Godinez Individual Corporate DirectorBoard of Directors May 18, 2021

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1831569540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 5TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794012622",
            "telephone_number": "806-765-2611",
            "fax_number": "806-687-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3502 9TH ST STE 280",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79415",
            "telephone_number": "806-791-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF LUBBOCK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "806-765-2611"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE A",
            "identifier": "741928",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362609501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.