The Providence Community Health Centers, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

Practice address

375 Allens Ave
Providence, RI 02905-5010

Phone

(401) 444-0400

Fax

(401) 444-0468

NPI assigned

Jan 20, 2006

Last updated

Dec 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Cabral

Title

Chief Financial Officer

Phone

(401) 444-0400

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in RI2 enrollments

Enrollment records 2

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1891775128. Details of each certification follow.

• CCN 411801 Federally qualified health center · Active · Details
• CCN 411818 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 411801

Legal name

THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.

Doing business as

PRAIRE AVENUE HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Mar 1, 1976 in RI

Enrollment address

355 Prairie Ave
Providence, RI 29051928

Federally qualified health center certification: CCN 411818

Legal name

THE PROVIDENCE COMMUNITY HEALTH CENTERS INC.

Doing business as

CAPITOL HILL HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 26, 2004

Last certification

Jan 26, 2004

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Mar 1, 1976 in RI

Enrollment address

40 Candace St
Providence, RI 29083747

Other NPIs on the same Medicare enrollment 4

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

• The Providence Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Providence, RI
  • NPI 1053313593

  O20030812000060, O20030812000063

  Same enrollment
• The Providence Community Health Centers, Inc

  dba Prairie Ave

  • Federally Qualified Health Center (FQHC)
  • Providence, RI
  • NPI 1417959867

  O20030812000060

  Same enrollment
• The Providence Community Health Centers, Inc.

  dba Central Health Center

  • Federally Qualified Health Center (FQHC)
  • Providence, RI
  • NPI 1508868035

  O20030812000060, O20030812000063

  Same enrollment
• The Providence Community Health Centers, Inc.

  dba Capitol Hill Health Center

  • Federally Qualified Health Center (FQHC)
  • Providence, RI
  • NPI 1669474102

  O20030812000063

  Same enrollment

All disclosed owners & managing parties 17

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

Owners & managing parties with NPI records 2

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

• J Russell Corcoran, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Wakefield, RI
  • NPI 1689661241

  Corporate Director

  CMS ownership
• Nocif Joseph Espat

  • Surgery Physician
  • Wakefield, RI
  • NPI 1225041361

  Corporate Director

  CMS ownership

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733356800000",
    "number": "1891775128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 ALLENS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055010",
            "telephone_number": "401-444-0400",
            "fax_number": "401-444-0468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 ALLENS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055010",
            "telephone_number": "401-444-0400",
            "fax_number": "401-444-0468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PROVIDENCE COMMUNITY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-20",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A",
        "authorized_official_last_name": "CABRAL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "401-444-0400"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Providence Community Health Centers, Inc. (PCHC Dental Clinic)
• The Providence Community Health Centers, Inc. (Central Health Center)
• The Providence Community Health Centers, Inc. (Capitol Hill Health Center)
• The Providence Community Health Centers, Inc. (Chad Brown Health Center)
• The Providence Community Health Centers, Inc. (Crossroads)
• The Rhode Island Coalition for the Homeless, Inc. (The Rhode Island Coalition to End Homelessness)
• The Rhode Island Nursing Middle College Charter School
• The Rhode Island Public Health Foundation (Open Door Health)
• The Serenity Stars
• The Stop & Shop Supermarket Company LLC (Stop and Shop Pharmacy #722)

• Federally Qualified Health Center (FQHC) in Providence, RI
• Providers in Providence, RI by specialty
• Federally Qualified Health Center (FQHC) in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.