NPIMap

Organization Active NPI

Third Street Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Marion, OH
National Provider Identifier
1861170565
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC INC
Practice address
320 Executive Dr
Marion, OH 43302-6310
Phone
(419) 522-6191
NPI assigned
Jul 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

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

Addresses

Primary practice location

320 Executive Dr
Marion, OH 43302-6310

Mailing address

1404 Park Ave W
Suite 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other names 1

  • Community Counseling & Wellness Centers-Marion Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230726001766 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Marion, OH
O20231215002895 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 28 practitioners
Practice locations: Marion, OH

Federally qualified health center certification: CCN D21023

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
COMMUNITY COUNSELING & WELLNESS CENTERS- MARION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2023
Last certification
Oct 1, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
320 Executive Dr
Marion, OH 43302-6310

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate Officer Jan 28, 2013
Corporate DirectorCfo Jan 28, 2013
W-2 Managing Employee Jan 28, 2013
James Dolan Individual Corporate DirectorChair Jan 23, 2018
Dorothy Stratton Individual Corporate DirectorVice Chair Feb 25, 2020
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Joe Stafford Individual Corporate DirectorBoard Member Oct 19, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Cindy Wetterau Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Jan 28, 2020
Julie Chaya Individual Corporate DirectorBoard Member Apr 24, 2022
Tom Walker Individual Corporate DirectorBoard Member Oct 19, 2023
Amber Wertman Individual Corporate DirectorSecretary Jan 28, 2020
Cody Albert Individual Corporate DirectorBoard Member Jan 28, 2020
Peggy S Anderson Individual Corporate OfficerCeo Sep 1, 2021
Corporate DirectorBoard Member Sep 1, 2021
W-2 Managing Employee Sep 1, 2021
Joe Devany Individual Corporate DirectorBoard Member Oct 19, 2023
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Mar 1, 2021
Corporate DirectorBoard Member Mar 1, 2021
W-2 Managing EmployeeCoo Mar 1, 2021
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

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 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1861170565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "SUITE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EXECUTIVE DR",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026310",
            "telephone_number": "419-522-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-11",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Counseling & Wellness Centers-Marion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Counseling & Wellness Centers-Marion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, OH

Sources for this page

Verify at the official NPI Registry.