NPIMap

Organization Active NPI

Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Leesburg, FL
National Provider Identifier
1881783124
Registry record updated Feb 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS, INC
Practice address
225 N 1St St
Leesburg, FL 34748-5150
Phone
(407) 905-8827
Fax
(352) 360-2389
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2018

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

Authorized official

Name
Margaret Brennan
Title
President/Ceo
Phone
(407) 905-8827

Specialties & licenses 1

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

Addresses

Primary practice location

225 N 1St St
Leesburg, FL 34748-5150

Mailing address

110 S Woodland St
Winter Garden, FL 34787-3546
Phone (407) 905-8827

Other identifiers 1

IdentifierTypeStateIssuer
029545112MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090325000728 FL Part A Provider - Federally Qualified Health Center (FQHC) 4082515390 Practice locations: Leesburg, FL

Federally qualified health center certification: CCN 101914

Legal name
COMMUNITY HEALTH CENTERS, INC
Doing business as
COMMUNITY HEALTH CENTER - LEESBURG
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 29, 1996
Last certification
Feb 29, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1972 in FL
Enrollment address
225 N 1St St
Leesburg, FL 34748-5150

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0870713Leesburg Community Health Center225 N 1St St, Leesburg, FL 34748Certificate of waiverOct 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Health Centersinc37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Locations

225 N 1st St
Leesburg, FL 34748
Phone (352) 314-7400

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Nilmarie Zapata-Colon Individual Corporate DirectorBoard of Directors Jul 26, 2018
Melissa Singh Individual Corporate DirectorBoard of Directors Aug 25, 2016
Diane Goodsell Individual W-2 Managing EmployeeAccounting Manager Sep 12, 2012
Karla Radka Individual Corporate DirectorBoard of Director Dec 2, 2014
Mark W Dickinson Individual Corporate OfficerExecutive Vice President/Cheif F Mar 14, 2011 100%
Timothy J McKinney Individual Corporate DirectorBoard Member May 30, 2013
Gisela Laurent Individual Corporate DirectorBoard of Directors Feb 22, 2018
Kathryn Jo Bailey Individual Corporate OfficerCoo Feb 3, 2019
W-2 Managing EmployeeCoo Feb 3, 2019
Darryl Owens Individual Corporate DirectorBoard of Directors May 24, 2018
Jerry Kassab Individual Corporate DirectorBoard of Directors Jun 22, 2017
Timothy Walker Individual Corporate DirectorBoard of Director May 15, 2015

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Community Health Centers, IncTavares, FL, CCN 681069 Federally qualified health center Operational/Managerial Control (100%) May 4, 2016
Community Health Centers, IncOrlando, FL, CCN 681099 Federally qualified health center Operational/Managerial Control (100%) Apr 25, 2017
Community Health Centers, IncClermont, FL, CCN 681120 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 19, 2018
Meadow Woods Health CenterOrlando, FL, CCN C11065 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 23, 2012

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1881783124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S WOODLAND ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873546",
            "telephone_number": "407-905-8827",
            "fax_number": "352-360-0762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N 1ST ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485150",
            "telephone_number": "407-905-8827",
            "fax_number": "352-360-2389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "407-905-8827"
    },
    "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": "029545112",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

Verify at the official NPI Registry.