NPIMap

Organization Active NPI

Camillus Health Concern Inc

  • Federally Qualified Health Center (FQHC)
  • Miami, FL
National Provider Identifier
1861402869
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMILLUS HEALTH CONCERN INC
Practice address
336 NW 5TH St
Miami, FL 33128-1616
Phone
(305) 577-4840
Fax
(305) 373-7431
NPI assigned
Aug 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Authorized official

Name
Francis Afram-Gyening
Title
Ceo
Phone
(305) 577-4840

Specialties & licenses 1

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

Addresses

Primary practice location

336 NW 5TH St
Miami, FL 33128-1616

Mailing address

336 NW 5TH St
Miami, FL 33128-1616
Phone (305) 577-4840

Other identifiers 2

IdentifierTypeStateIssuer
680002500MedicaidFL
680002501MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000614 FL Part B Supplier - Clinic/Group Practice 4688575210 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
Practice locations: Miami, FL
O20080910000471 FL Part A Provider - Federally Qualified Health Center (FQHC) 4688575210 Practice locations: Miami, FL

Federally qualified health center certification: CCN 101929

Legal name
CAMILLUS HEALTH CONCERN INC
Doing business as
GOOD SHEPHERD HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2001
Last certification
Jan 15, 2001
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1988 in FL
Enrollment address
336 NW 5TH St
Miami, FL 33128-1616

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Camillus Health Concern Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Networks

  • HealthSun Health Plans Network

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
Catherine Lang-Robinson Individual Corporate DirectorDirector of HR / Corporate Compl Jun 9, 2014
W-2 Managing EmployeeDirector of HR / Corporate Compl Jun 9, 2014
Evan Piper Individual Corporate DirectorBoard of Directors Mar 22, 2013
John Dubois Individual Corporate DirectorBoard of Directors Aug 26, 2009
Francis Afram-Gyening Individual Corporate DirectorCeo May 15, 2017
W-2 Managing EmployeeCeo May 15, 2017 100%
Malou Harrison Individual Corporate DirectorBoard of Directors Jan 1, 2014
Charles Magoffin Individual Corporate DirectorBoard of Directors Jun 14, 2017
McKenley Romeo Individual Corporate DirectorBoard of Directors Jan 1, 2014
Marie Dezelick Individual Corporate DirectorBoard of Directors Sep 23, 2016
Bryan Person Individual Corporate DirectorBoard of Directors Jun 14, 2017
Vincent Vento Individual Corporate DirectorBoard of Directors Jul 29, 2011
Thomas Abraham Individual Corporate DirectorBoard of Directors Jul 20, 2011
Ana Viamonte Ros Individual Corporate DirectorBoard of Directors Mar 18, 2011

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Salvation ArmyMiami, FL, CCN 691058 Federally qualified health center Operational/Managerial Control (100%) Aug 13, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 31

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

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1861402869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 NW 5TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331281616",
            "telephone_number": "305-577-4840",
            "fax_number": "305-373-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 NW 5TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331281616",
            "telephone_number": "305-577-4840",
            "fax_number": "305-373-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILLUS HEALTH CONCERN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "AFRAM-GYENING",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-577-4840"
    },
    "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": "680002500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "680002501",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.