NPIMap

Organization Active NPI

Five Rivers Health Centers

Doing business as Five Rivers Health Centers at St. Vincent De Paul

  • Federally Qualified Health Center (FQHC)
  • Dayton, OH
National Provider Identifier
1871190728
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FIVE RIVERS HEALTH CENTERS
Doing business as
Five Rivers Health Centers at St. Vincent De Paul
Practice address
120 W Apple St Ste 100
Dayton, OH 45402-2617
Phone
(937) 734-4141
NPI assigned
Oct 5, 2020
Last updated
Oct 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Authorized official

Name
Gina McFarlane-El
Title
Ceo
Phone
(937) 208-2284

Specialties & licenses 1

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

Addresses

Primary practice location

120 W Apple St Ste 100
Dayton, OH 45402-2617

Mailing address

2261 Philadelphia Dr
Dayton, OH 45406-1814

Other names 1

  • Five Rivers Health Centers at St. Vincent De Paul Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL https://www.fiverivershealthcenters.org/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210520002946 OH Part A Provider - Federally Qualified Health Center (FQHC) 9335300904 Practice locations: Dayton, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871190728. Details of each certification follow.

Federally qualified health center certification: CCN 721894

Legal name
FIVE RIVERS HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2021
Last certification
Oct 1, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 2011 in OH
Enrollment address
120 W Apple St
Ste C
Dayton, OH 45402-2617

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Five Rivers Health Centers19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Mamle Anim Individual Corporate OfficerChief Medical Officer May 23, 2011
Brenda Jean Roman Individual Corporate DirectorBoard Member Apr 13, 2016
Diane Welborn Individual Corporate DirectorBoard Member Apr 1, 2012
Dwight Brown Individual Corporate DirectorBoard Member Apr 1, 2012
Jo Bouchard Individual Corporate DirectorBoard Member May 11, 2017
Richard Goshay Individual Corporate DirectorBoard Member Apr 1, 2012
Tara Roesch Individual Corporate OfficerChief Financial Officer Nov 1, 2018
Gina M McFarlane-El Individual Corporate OfficerChief Executive Officer May 23, 2011 100%
Operational/Managerial Control May 23, 2011 100%
Dawn Walker Individual Corporate DirectorBoard Member Jun 12, 2018
Amy Wiedeman Individual Corporate DirectorBoard Member Apr 1, 2012

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Five Rivers Health CentersDayton, OH, CCN 361007 Federally qualified health center Operational/Managerial Control (100%) May 23, 2011

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1871190728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2261 PHILADELPHIA DR",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454061814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W APPLE ST STE 100",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454022617",
            "telephone_number": "937-734-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE RIVERS HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-05",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "MCFARLANE-EL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-208-2284"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.fiverivershealthcenters.org/",
            "affiliation": "N",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "WebPortal",
            "address_1": "120 W Apple St Ste 100",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454022617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Five Rivers Health Centers at St. Vincent De Paul",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.