NPIMap

Organization Active NPI

Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Groveland, FL
National Provider Identifier
1922197243
Registry record updated Feb 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS, INC
Practice address
1296 W Broad St
Groveland, FL 34736-2012
Phone
(407) 905-8827
Fax
(352) 429-5606
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2018

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

Authorized official

Name
Margaret Brennan
Title
President/Ceo
Phone
(407) 905-8827

Specialties & licenses 1

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

Addresses

Primary practice location

1296 W Broad St
Groveland, FL 34736-2012

Mailing address

110 S Woodland St
Winter Garden, FL 34787-3546
Phone (407) 905-8827

Other identifiers 1

IdentifierTypeStateIssuer
029545110MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090211000106 FL Part A Provider - Federally Qualified Health Center (FQHC) 4082515390 Practice locations: Groveland, FL

Federally qualified health center certification: CCN 101860

Legal name
COMMUNITY HEALTH CENTERS, INC
Doing business as
SOUTH LAKE FAMILY 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 – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1972 in FL
Enrollment address
1296 West Broad Street
Groveland, FL 34736-2012

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Community Health Centersinc37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Nilmarie Zapata-Colon Individual Corporate Director Jul 26, 2018
Melissa Singh Individual Corporate Director Aug 25, 2016
Diane Goodsell Individual W-2 Managing EmployeeAccounting Manager Sep 12, 2012
Karla Radka Individual Corporate DirectorBoard of Director Dec 2, 2014
Mark W Dickinson Individual Corporate OfficerCfo Mar 14, 2011
Debra Andree Individual Corporate OfficerChief Executive Officer Jun 30, 2013 100%
Gisela Laurent Individual Corporate Director Feb 22, 2018
Darryl Owens Individual Corporate Director May 24, 2018
Felicia Davis Individual Corporate Director Feb 1, 2021
Jerry Kassab Individual Corporate Director Jun 22, 2017
Timothy Walker Individual Corporate Director May 15, 2015

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 4

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

FacilityTypeRoleSince
Community Health Centers, IncTavares, FL, CCN 681069 Federally qualified health center Operational/Managerial Control (100%) May 4, 2016
Community Health Centers, IncOrlando, FL, CCN 681099 Federally qualified health center Operational/Managerial Control (100%) Apr 25, 2017
Community Health Centers, IncClermont, FL, CCN 681120 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 19, 2018
Meadow Woods Health CenterOrlando, FL, CCN C11065 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 23, 2012

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

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": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1922197243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S WOODLAND ST",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347873546",
            "telephone_number": "407-905-8827",
            "fax_number": "352-429-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 W BROAD ST",
            "city": "GROVELAND",
            "state": "FL",
            "postal_code": "347362012",
            "telephone_number": "407-905-8827",
            "fax_number": "352-429-5606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "BRENNAN",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "407-905-8827"
    },
    "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": "029545110",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Groveland, FL

Sources for this page

Verify at the official NPI Registry.