NPIMap

Organization Active NPI

Nevada Health Centers, Inc.

Doing business as Willow Street Health Center

  • Federally Qualified Health Center (FQHC)
  • Reno, NV
National Provider Identifier
1952009151
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEVADA HEALTH CENTERS, INC.
Doing business as
Willow Street Health Center
Practice address
790 Willow St
Reno, NV 89502-1304
Phone
(775) 887-5140
NPI assigned
Feb 17, 2023
Last updated
Feb 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
NEVADA HEALTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Authorized official

Name
Carrie Black
Title
Provider Relations Manager
Phone
(775) 888-6610

Specialties & licenses 1

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

Addresses

Primary practice location

790 Willow St
Reno, NV 89502-1304

Mailing address

3325 Research Way
Carson City, NV 89706-7913

Other names 1

  • Willow Street Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20231011003952 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Reno, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952009151. Details of each certification follow.

Federally qualified health center certification: CCN 291009

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
WILLOW STREET HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 11, 2023
Last certification
Oct 11, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
790 Willow St BLDG
Reno, NV 89502-1304

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 34

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

View all 34

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2278951Willow Street Health Center790 Willow Street, Reno, NV 89502Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Fernley Family Medical34 organizations share this tax ID, including this one
Part of
Fernley Family Medical

Other organizations with this tax ID 33

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

View all 33

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Alan Herak Individual Corporate DirectorBoard Member Jul 1, 2023
Donald E Chaney Individual Corporate DirectorBoard Member Jun 1, 2013
Timothy Blakely Individual Corporate DirectorBoard Member Jun 1, 2018
Lyn Beggs Individual Corporate DirectorBoard Member Jun 1, 2022
Jeff Snyder Individual Corporate DirectorBoard Chair Jun 1, 2017
Alicia Y Barnes Individual Corporate DirectorBoard Member Jun 1, 2013
Gerald Ackerman Individual Corporate DirectorBoard Secretary Jun 1, 2012
Tom Zumtobel Individual Corporate DirectorBoard Member Jun 1, 2022
Linda Bingaman Individual Corporate DirectorBoard Treasurer Jun 1, 2012
Kathryn L Triplett Individual Corporate OfficerCfo Oct 3, 2016 50%
W-2 Managing EmployeeCfo Oct 3, 2016 50%
Nevada Health Centers Inc Organization, Carson City, NV Non-profit 5% Or Greater Direct Ownership Interest Aug 22, 2023 100%
Maurice Washington Individual Corporate DirectorBoard Vice Chair Jun 1, 2014
Jared Carter Individual Corporate DirectorBoard Member Jun 1, 2009
Walter B Davis Individual Corporate OfficerCeo Nov 26, 2012 50%
W-2 Managing EmployeeCeo Nov 26, 2012 50%

Owners & managing parties with NPI records 24

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

View all 24

All facility ownership & control disclosures 13

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Eastern Family Medical and Dental CenterLas Vegas, NV, CCN 291837 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2010
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers Carson City School BasedCarson City, NV, CCN 291854 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 21, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children's Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

Owned or controlled facilities with NPI records 13

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

View all 13

Facilities with the same owner 13

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1952009151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 WILLOW ST",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021304",
            "telephone_number": "775-887-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEVADA HEALTH CENTERS, INC.",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "PROVIDER RELATIONS MANAGER",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Street Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.