NPIMap

Organization Active NPI

Vernon J Harris East End Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
National Provider Identifier
1881883007
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
Practice address
2809 North Ave
Richmond, VA 23222-3647
Phone
(804) 780-0840
Fax
(804) 329-1206
NPI assigned
Oct 24, 2007
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 Primary

Addresses

Primary practice location

2809 North Ave
Richmond, VA 23222-3647

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1881883007MedicaidVA

Other names 1

  • Capital Area Health Network - Northside 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
O20080926000601 VA Part A Provider - Federally Qualified Health Center (FQHC) 9638064850 Practice locations: Richmond, VA

Federally qualified health center certification: CCN 491889

Legal name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Doing business as
NORTHSIDE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2008
Last certification
Dec 5, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1999 in VA
Enrollment address
2809 North Ave 206
Richmond, VA 23222-3647

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

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
Vanessa Cabra Individual Corporate DirectorMember Jul 24, 2012
Wilma Harris Individual Corporate DirectorTreasurer Jul 24, 2012
Roscoe Cooper Individual Corporate DirectorPresident Jul 22, 2008
Tracy Causey Individual Corporate DirectorCeo Jan 13, 2003
W-2 Managing EmployeeCeo Jan 13, 2003
Operational/Managerial ControlCeo Jan 13, 2003
Michelle Hall Individual Corporate DirectorMember Feb 26, 2013
Darrell Johnson Individual Corporate DirectorMember Aug 26, 2014
Daniel Herlihy Individual Corporate DirectorVice President Jul 24, 2007
Jeffery Marshall Individual Corporate DirectorMember Jul 24, 2012
Denizez Moss Individual Corporate DirectorMember Feb 26, 2013
Anna Ruth Staton Individual Corporate DirectorMember Jan 25, 2011

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.

NPI Registry JSON

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

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1881883007",
    "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": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647",
            "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": "2007-10-24",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881883007",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capital Area Health Network - Northside Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.