NPIMap

Organization Active NPI

Community Health Center of Pinellas Inc

Doing business as Evara Health

  • Federally Qualified Health Center (FQHC)
  • St Petersburg, FL
National Provider Identifier
1902884620
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF PINELLAS INC
Doing business as
Evara Health
Practice address
1344 22ND St S
St Petersburg, FL 33712-2744
Phone
(727) 821-6701
Fax
(727) 823-7429
NPI assigned
Jan 3, 2006
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF PINELLAS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Edward Kucher
Title
Chief Regulatory Officer
Phone
(727) 824-8100

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1344 22ND St S
St Petersburg, FL 33712-2744

Mailing address

PO Box 10549
St Petersburg, FL 33733-0549
Phone (727) 824-8126

Other identifiers 2

IdentifierTypeStateIssuer
029565500MedicaidFL
060638300MedicaidFL

Other names 1

  • Evara Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120524000477 FL Part A Provider - Federally Qualified Health Center (FQHC) 8527961028 Practice locations: Saint Petersburg, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902884620. Details of each certification follow.

Federally qualified health center certification: CCN 101926

Legal name
COMMUNITY HEALTH CENTER OF PINELLAS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 6, 1999
Last certification
Jul 6, 1999
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Nov 14, 1980 in FL
Enrollment address
1344 22ND St S
Saint Petersburg, FL 33712-2744

Other NPIs with the same Medicare PAC ID 19

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

View all 19

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center of Pinellas Inc24 organizations share this tax ID, including this one
Part of
Community Health Center of Pinellas Inc

Other organizations with this tax ID 23

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

View all 23

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Joseph Smith Individual Corporate DirectorVice Chair Apr 9, 2012
Elodie Dorso Individual Corporate DirectorCeo Feb 2, 2018
W-2 Managing EmployeeCeo Aug 1, 2014 100%
Operational/Managerial ControlCeo Feb 2, 2018 100%
Cindy McNulty Individual Corporate DirectorSecretary Jan 1, 2016
Frances Serrano Lux Individual Corporate DirectorChair Jan 1, 2016
Luke Williams Individual Corporate DirectorBoard Member Apr 9, 2012
Edward Kucher Individual Corporate DirectorCoo Mar 16, 2018
W-2 Managing EmployeeCoo Feb 27, 2017

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1902884620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10549",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337330549",
            "telephone_number": "727-824-8126",
            "fax_number": "727-824-8166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 22ND ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337122744",
            "telephone_number": "727-821-6701",
            "fax_number": "727-823-7429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF PINELLAS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTER OF PINELLAS INC",
        "enumeration_date": "2006-01-03",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "KUCHER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF REGULATORY OFFICER",
        "authorized_official_telephone_number": "727-824-8100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029565500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "060638300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evara Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.