Optimus Health Care Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

0388 Issued in CT

Legal business name

OPTIMUS HEALTH CARE INC

Doing business as

Park City Primary Care Center

Practice address

64 Black Rock Ave
Bridgeport, CT 06605-1200

Phone

(203) 579-5000

Fax

(203) 332-0376

NPI assigned

Dec 30, 2011

Organization subpart

No

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

Addresses

Other identifiers 2

Other names 1

• Park City Primary Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932479409. Details of each certification follow.

• CCN 071880 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 071880

Legal name

OPTIMUS HEALTH CARE INC

Doing business as

PARK CITY PRIMARY CARE CENTER INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 5, 2011

Last certification

Dec 5, 2011

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Dec 9, 1976 in CT

Enrollment address

64 Black Rock Ave
Bridgeport, CT 66051200

Other NPIs on the same Medicare enrollment 2

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

• Optimus Health Care

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bridgeport, CT
  • NPI 1992871875

  O20110929000015

  Same enrollment
• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
  • NPI 1669445946

  O20110929000015

  Same enrollment

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.

Owners & managing parties with NPI records 1

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

• Henry Yoon, M.D.

  • Family Medicine Physician
  • Stamford, CT
  • NPI 1790786259

  Corporate Director

  CMS ownership

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": "1932479409",
    "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": "64 BLACK ROCK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051200",
            "telephone_number": "203-579-5000",
            "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": "0388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "C00383",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004234788",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park City Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Optimus Health Care Inc (Hollow Community Health Center)
• Optimus Health Care Inc
• Optimus Health Care Inc (JP Morgan Chase Wellness Center)
• Optimus Health Care Inc
• Optimus Health Care Inc
• Optimus Healthcare
• Oral Surgery Associates, L.L.C
• Iveliz Oramas
• Pinar Oray-Schrom, MD
• John J Orazietti, CRNA

• Federally Qualified Health Center (FQHC) in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Federally Qualified Health Center (FQHC) in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; 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.