NPIMap

Organization Active NPI

Optimus Health Care Inc

Doing business as Stratford Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Stratford, CT
National Provider Identifier
1922378496
Registry record updated Dec 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0234 Issued in CT
Legal business name
OPTIMUS HEALTH CARE INC
Doing business as
Stratford Community Health Center
Practice address
727 Honeyspot Rd
Stratford, CT 06615-7172
Phone
(203) 375-7252
Fax
(203) 332-0376
NPI assigned
Dec 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2011

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

Authorized official

Name
Ludwig Spinelli
Title
Chief Executive Officer
Phone
(203) 696-3260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0234 CT Primary

Addresses

Primary practice location

727 Honeyspot Rd
Stratford, CT 06615-7172

Mailing address

982 E Main St
Bridgeport, CT 06608-1913
Phone (203) 696-3260

Other identifiers 2

IdentifierTypeStateIssuer
004234788MedicaidCT
C00383OtherCTMEDICARE PART B

Other names 1

  • Stratford Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080304000508 CT Part A Provider - Federally Qualified Health Center (FQHC) 9335051580 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stratford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922378496. Details of each certification follow.

Federally qualified health center certification: CCN 071811

Legal name
OPTIMUS HEALTH CARE INC
Doing business as
STRATFORD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 18, 1995
Last certification
Dec 18, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1976 in CT
Enrollment address
305 Boston Ave
Stratford, CT 66145246

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

Locations

727 Honeyspot Rd
Stratford, CT 06615
Phone (203) 375-7242

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
Colleen Ebankks-Shippey Individual Corporate DirectorBoard Member Jan 1, 2022
Bertcelis Morales Individual Corporate DirectorBoard Member Jan 1, 2022
Karen a Daley Individual Corporate DirectorCeo Jan 1, 2022
W-2 Managing EmployeeCeo Aug 1, 2021
Carlos de la Iglesia Individual Corporate DirectorBoard Member Jan 1, 2022
Mack H Allen Individual Corporate DirectorBoard Member Jan 1, 2022
Katherine a Golar Individual Corporate DirectorCmo Mar 1, 2021
W-2 Managing EmployeeCmo Mar 1, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1922378496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "203-696-3260",
            "fax_number": "203-332-0376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "727 HONEYSPOT RD",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066157172",
            "telephone_number": "203-375-7252",
            "fax_number": "203-332-0376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUS HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "SPINELLI",
        "authorized_official_first_name": "LUDWIG",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-696-3260"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004234788",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "C00383",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stratford Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratford, CT

Sources for this page

Verify at the official NPI Registry.