NPIMap

Organization Active NPI

Five Rivers Health Centers

  • Federally Qualified Health Center (FQHC)
  • Dayton, OH
National Provider Identifier
1891466280
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FIVE RIVERS HEALTH CENTERS
Practice address
721 Miami Chapel Rd
Dayton, OH 45417
Phone
(937) 208-8585
NPI assigned
Sep 24, 2021
Last updated
Feb 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

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

Authorized official

Name
Gina McFarlane-El
Title
Ceo
Phone
(937) 734-6841

Specialties & licenses 1

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

Addresses

Primary practice location

721 Miami Chapel Rd
Dayton, OH 45417

Mailing address

721 Miami Chapel Rd
Dayton, OH 45417-4650
Phone (937) 281-6900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220430000045 OH Part A Provider - Federally Qualified Health Center (FQHC) 9335300904 Practice locations: Dayton, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891466280. Details of each certification follow.

Federally qualified health center certification: CCN 721010

Legal name
FIVE RIVERS HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2022
Last certification
Mar 29, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 2011 in OH
Enrollment address
721 Miami Chapel Rd
Dayton, OH 45417-4650

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Five Rivers Health Centers19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

721 Miami Chapel Rd
Dayton, OH 45417
Phone (937) 281-5970

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
Mamle Anim Individual Corporate OfficerChief Medical Officer May 23, 2011
Brenda Jean Roman Individual Corporate DirectorBoard Member Apr 13, 2016
Diane Welborn Individual Corporate DirectorBoard Member Apr 1, 2012
Dwight Brown Individual Corporate DirectorBoard Member Apr 1, 2012
Jo Bouchard Individual Corporate DirectorBoard Member May 11, 2017
Richard Goshay Individual Corporate DirectorBoard Member Apr 1, 2012
Tara Roesch Individual Corporate OfficerCfo Nov 1, 2018
Gina M McFarlane-El Individual Corporate OfficerCeo May 23, 2011 100%
Operational/Managerial ControlCeo May 23, 2011 100%
Dawn Walker Individual Corporate DirectorBoard Member Jun 12, 2018
Amy Wiedeman Individual Corporate DirectorBoard Member Apr 1, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Five Rivers Health CentersDayton, OH, CCN 361007 Federally qualified health center Operational/Managerial Control (100%) May 23, 2011

Owned or controlled facilities with NPI records 1

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": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1891466280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174650",
            "telephone_number": "937-281-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MIAMI CHAPEL RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45417",
            "telephone_number": "937-208-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE RIVERS HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "MCFARLANE-EL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-734-6841"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.