NPIMap

Organization Active NPI

Escambia Community Clinics Inc

  • Federally Qualified Health Center (FQHC)
  • Pensacola, FL
National Provider Identifier
1841487634
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESCAMBIA COMMUNITY CLINICS INC
Practice address
2315 W Jackson St
Pensacola, FL 32505-7552
Phone
(850) 436-4630
Fax
(850) 436-2095
NPI assigned
Sep 26, 2007
Last updated
Nov 30, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
ESCAMBIA COMMUNITY CLINICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

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

Authorized official

Name
Chandra Smiley
Title
Executive Director
Phone
(850) 436-4630

Specialties & licenses 1

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

Addresses

Primary practice location

2315 W Jackson St
Pensacola, FL 32505-7552

Mailing address

2315 W Jackson St
Pensacola, FL 32505-7552
Phone (850) 436-4630

Other identifiers 1

IdentifierTypeStateIssuer
6929907-00MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422001135 FL Part B Supplier - Clinic/Group Practice 9638165806 Receives reassigned benefits from 65 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pensacola, FL; Pace, FL; Milton, FL; Century, FL; Cantonment, FL
O20070928000271 FL Part A Provider - Federally Qualified Health Center (FQHC) 9638165806 Practice locations: Pensacola, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841487634. Details of each certification follow.

Federally qualified health center certification: CCN 101808

Legal name
ESCAMBIA COMMUNITY CLINICS INC
Doing business as
COMMUNITY HEALTH NORTHWEST FLORIDA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 15, 2007
Last certification
Nov 15, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 29, 1992 in FL
Enrollment address
2315 W Jackson St
Pensacola, FL 32505-7552

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Escambia Community Clinics Inc

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

5520 Stewart St
Milton, FL 32570
Phone (850) 891-9433

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Grace McCaffery Individual Corporate DirectorBoard Member Jul 29, 2021
Bob Wilson Individual Corporate DirectorBoard Member Sep 1, 2017
Freddie Cattouse Individual Corporate OfficerBoard Member Sep 1, 2007
Shirley Henderson Individual Corporate DirectorBoard Member Dec 31, 2022
Dorothy Foster Individual Corporate DirectorBoard Member Apr 1, 2017
Ann Osiname Individual Corporate DirectorBoard Member Sep 3, 2007
Chandra Smiley Individual Corporate OfficerExecutive Director Dec 1, 2014
W-2 Managing EmployeeExecutive Director Dec 1, 2014
Operational/Managerial ControlExecutive Director Dec 1, 2014
Jules Kariher Individual Corporate DirectorVice Chairman Oct 1, 2017
Justin H Labrato Individual Corporate DirectorTreasurer Mar 1, 2014
Brett Aldridge Individual Corporate DirectorBoard Member Jul 1, 2018
John T Porter Individual Corporate DirectorChairman Sep 3, 2007
Thomas Owens Individual Corporate DirectorBoard Member Dec 31, 2022
Sean Seely Individual Corporate DirectorBoard Member Apr 1, 2017

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Northwest FloridaPensacola, FL, CCN 681048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 29, 1992
Community Health Northwest FloridaPensacola, FL, CCN 681849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1841487634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "enumeration_date": "2007-09-26",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-436-4630"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6929907-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.