NPIMap

Organization Active NPI

Premier Community Health Care Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Dade City, FL
National Provider Identifier
1881928869
Registry record updated Apr 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PREMIER COMMUNITY HEALTH CARE GROUP, INC.
Practice address
37944 Pasco Ave
Dade City, FL 33525-4202
Phone
(352) 518-2000
Fax
(352) 518-2000
NPI assigned
Sep 24, 2009
Last updated
Apr 12, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2019

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

Authorized official

Name
Joseph Resnick
Title
Ceo
Phone
(352) 518-2000

Specialties & licenses 1

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

Addresses

Primary practice location

37944 Pasco Ave
Dade City, FL 33525-4202

Mailing address

PO Box 232
Dade City, FL 33526-0232
Phone (352) 518-2000

Other identifiers 1

IdentifierTypeStateIssuer
029550700MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110225000334 FL Part A Provider - Federally Qualified Health Center (FQHC) 3476450818 2 other NPIs on this enrollment
Practice locations: Zephyrhills, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881928869. Details of each certification follow.

Federally qualified health center certification: CCN 101064

Legal name
PREMIER COMMUNITY HEALTH CARE GROUP INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2011
Last certification
Jan 19, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1979 in FL
Enrollment address
38030 Daughtery Rd
Zephyrhills, FL 33540-1375

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Joseph Resnick Individual 5% Or Greater Indirect Ownership Interest Sep 1, 2014 100%
Corporate OfficerCeo Sep 1, 2014 100%
W-2 Managing EmployeeCeo Sep 1, 2014 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Premier Community Health Care Group IncNew Port Richey, FL, CCN 101042 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2009
Premier Community Health Care Group IncZephyrhills, FL, CCN 681144 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2019

Owned or controlled facilities with NPI records 2

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": "1253750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555027200000",
    "number": "1881928869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335260232",
            "telephone_number": "352-518-2000",
            "fax_number": "352-567-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37944 PASCO AVE",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335254202",
            "telephone_number": "352-518-2000",
            "fax_number": "352-518-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER COMMUNITY HEALTH CARE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-24",
        "last_updated": "2019-04-12",
        "status": "A",
        "authorized_official_last_name": "RESNICK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-518-2000"
    },
    "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": "029550700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dade City, FL

Sources for this page

Verify at the official NPI Registry.