NPIMap

Organization Active NPI

Collier Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Naples, FL
National Provider Identifier
1871366427
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES, INC
Practice address
1090 6TH Ave N
Naples, FL 34102-5604
Phone
(239) 658-3000
NPI assigned
Nov 6, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Tami Raznoff, MBA
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

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

Addresses

Primary practice location

1090 6TH Ave N
Naples, FL 34102-5604

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other names 1

  • Healthcare Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240221001495 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Naples, FL

Federally qualified health center certification: CCN C11010

Legal name
COLLIER HEALTH SERVICES, INC
Doing business as
HEALTHCARE NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 21, 2024
Last certification
Feb 21, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 17, 1977 in FL
Enrollment address
1090 6TH Ave N
Naples, FL 34102-5604

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Collier Health Services Central Naples Pediatrics79 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

6350 Davis Blvd
Unit 1001
Naples, FL 34104

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
Jamie Ulmer Individual Corporate OfficerCeo Jan 1, 2024
Haris Domond Individual Corporate DirectorBoard Member Jan 1, 2020
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021
Maria Munguia Individual Corporate DirectorBoard Member Jan 1, 2024
John Fletcher Individual Corporate OfficerCoo Oct 18, 2021
Tami Raznoff Individual Corporate OfficerCfo Jan 1, 2020
W-2 Managing EmployeeCfo Jan 1, 2020
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018
Jean Casnel Paul Individual Corporate DirectorBoard Member Jan 1, 2020
Alejandro Castano Individual Corporate DirectorBoard Member Jul 22, 2021
Jerry Starkey Individual Corporate DirectorBoard Member Jan 1, 2020
James Douglas Campbell Individual Corporate DirectorBoard Member Jan 1, 2020

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": "1699228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1871366427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 6TH AVE N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341025604",
            "telephone_number": "239-658-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-06",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136",
        "authorized_official_credential": "MBA"
    },
    "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": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.