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Christ Community Health Services, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Memphis, TN

NPI 1922582816 · NPPES record last updated Dec 6, 2024

Key facts

NPI
1922582816
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES, INC.
Practice address
1325 Jefferson Ave
Memphis, TN 38104-2013
Phone
(901) 701-2530
Fax
(701) 701-2536
NPI assigned
Sep 18, 2018
Organization subpart
No

Authorized official

Name
Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Other NPIs on the same Medicare enrollment 14

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 22

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

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 62

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2165216CCHS Operation Outreach Health Center
1325 Jefferson Ave, Memphis, TN 38104		Provider-performed microscopyApr 22, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TN

Federally qualified health center certification: CCN 441987

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 23, 2018
Last certification
Oct 23, 2018
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Enrollment address
1325 Jefferson Ave
Memphis, TN 38104-2013

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Shantelle N Leatherwood
Individual 		Corporate Officer
Ceo		 Oct 1, 2018
Corporate Director
Ceo		 Oct 1, 2018
W-2 Managing Employee
Ceo		 Oct 1, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20181018001035 TN Part a Provider - Federally Qualified Health Center (FQHC) 3870402084 Practice locations: Memphis, TN

National Provider Directory

Tax ID family
Christ Community Health Services Inc (23 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

1325 Jefferson Ave
Memphis, TN 38104-2013

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 260-8500

Other identifiers

IdentifierTypeStateIssuer
3707256MedicaidTN

Other names

  • CCHS Operation Outreach Health Center Doing business as

Other providers in Memphis, TN

All providers in Memphis, TN · Federally Qualified Health Center (FQHC) in Tennessee

Sources for this page

Verify at the official NPI Registry.