NPIMap

Organization Active NPI

Chase Brexton Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Windsor Mill, MD
National Provider Identifier
1851320147
Registry record updated Feb 22, 2024
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.
Practice address
6901 Security Blvd Ste 200
Windsor Mill, MD 21244-2412
Phone
(410) 837-2050
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Authorized official

Name
Kyle Easton
Title
Revenue Cycle Director
Phone
(667) 260-7924

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

6901 Security Blvd Ste 200
Windsor Mill, MD 21244-2412

Mailing address

1111 North Charles Street
Baltimore, MD 21201
Phone (410) 837-2050

Other identifiers 1

IdentifierTypeStateIssuer
132190102MedicaidMD

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
O20100908000867 MD Part A Provider - Federally Qualified Health Center (FQHC) 5395644835 1 other NPI on this enrollment
Practice locations: Windsor Mill, MD

Federally qualified health center certification: CCN 211850

Legal name
CHASE BREXTON HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2005
Last certification
Dec 6, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1989 in MD
Enrollment address
6901 Security Blvd
Ste 200
Windsor Mill, MD 21244-2412

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

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

3510 Brenbrook Dr
Randallstown, MD 21133
Phone (410) 496-6441

Ownership & related parties

All disclosed owners & managing parties 17

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%
Alaysia Phillips Individual Corporate DirectorBoard Jan 1, 2023 5%
Kyle Easton Individual OtherRevenue Cycle Director Dec 1, 2016
Joe Ferlise Individual Corporate DirectorBoard Jan 1, 2022
Patrick Mutch Individual Contracted Managing EmployeeCeo Mar 1, 2017 50%
Corporate OfficerCeo Mar 1, 2017 50%
Russell Montgomery Individual Corporate DirectorBoard Jan 1, 2022 5%
Rahul Gor Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Oscar Franklin Individual Corporate DirectorBoard Jan 1, 2023 5%
Kaye Gooche Individual Corporate DirectorBoard Jan 1, 2022 5%
Julia Krieger Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Lois Anderson Individual Corporate DirectorBoard Jan 1, 2023 5%
Falayrium Burden Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Tina Jones Individual Corporate DirectorBoard Jan 1, 2023 5%
Damian Crawford Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Neijma Celestine-Donnor Individual Corporate DirectorBoard Jan 1, 2023 5%
Eric Richard Turnbaugh Individual Corporate OfficerCfo Sep 16, 2019 25%
Jessica Obyan Individual Corporate DirectorBoard Jan 1, 2021 5%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 119

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

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1851320147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 NORTH CHARLES STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "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": "6901 SECURITY BLVD STE 200",
            "city": "WINDSOR MILL",
            "state": "MD",
            "postal_code": "212442412",
            "telephone_number": "410-837-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASE BREXTON HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "667-260-7924"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132190102",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Windsor Mill, MD

Sources for this page

Verify at the official NPI Registry.