NPIMap

Organization Active NPI

Vernon J Harris East End Community Health Center

Doing business as Capital Area Health Network - Southside Medical Center

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
National Provider Identifier
1871818153
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Doing business as
Capital Area Health Network - Southside Medical Center
South Side Medical Center
Practice address
101 Cowardin Ave
Suite 102
Richmond, VA 23224-2078
Phone
(804) 780-0840
Fax
(804) 329-1206
NPI assigned
Mar 30, 2010
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
Tracy Causey
Title
Chief Executive Officer
Phone
(804) 253-1968

Specialties & licenses 1

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

Addresses

Primary practice location

101 Cowardin Ave
Suite 102
Richmond, VA 23224-2078

Mailing address

2809 North Ave
Richmond, VA 23222-3647
Phone (804) 780-0840

Other names 2

  • Capital Area Health Network - Southside Medical Center Doing business as
  • South Side Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000877 VA Part B Supplier - Clinic/Group Practice 9638064850 Receives reassigned benefits from 49 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Chesterfield, VA; Richmond, VA
O20111011000463 VA Part A Provider - Federally Qualified Health Center (FQHC) 9638064850 Practice locations: Richmond, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871818153. Details of each certification follow.

Federally qualified health center certification: CCN 491909

Legal name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 12, 2011
Last certification
Oct 12, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
101 Cowardin Ave
Ste 102
Richmond, VA 23224-2078

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Vernon J Harris East En

Locations

1718 Williamsburg Rd
Richmond, VA 23231

2809 North Ave
Richmond, VA 23222
Phone (804) 321-2403

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Vanessa Cabra Individual Other Jan 1, 2016
Wilma Harris Individual Other Jan 1, 2016
Roscoe Cooper Individual Corporate Director Mar 29, 2010
Tracy Causey Individual Corporate Director Mar 29, 2010
W-2 Managing Employee Mar 29, 2010
Michelle Hall Individual Other Jan 1, 2016
Betty Drummond Individual Corporate Officer Mar 29, 2010
Corporate Director Mar 29, 2010
Darrell Johnson Individual Corporate Officer Jan 1, 2016
Denizez Moss Individual Corporate OfficerVice President Jan 1, 2016
Anna Ruth Staton Individual Corporate Director Mar 29, 2010

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1871818153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647",
            "telephone_number": "804-780-0840",
            "fax_number": "804-329-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 COWARDIN AVE",
            "address_2": "SUITE 102",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232242078",
            "telephone_number": "804-780-0840",
            "fax_number": "804-329-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "enumeration_date": "2010-03-30",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "CAUSEY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "804-253-1968"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Area Health Network - Southside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Side Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Side Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.