Organization Active NPI

Charles Drew Health Center, Inc

Federally Qualified Health Center (FQHC)
Omaha, NE

National Provider Identifier

1952659930

Registry record updated Mar 19, 2021

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
NPI Registry JSON
Other providers in Omaha, NE
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name: CHARLES DREW HEALTH CENTER, INC
Practice address: 5100 Florence Blvd
Omaha, NE 68110-5346
Phone: (402) 457-1241
Fax: (402) 457-1930
NPI assigned: Aug 22, 2012
Organization subpart: Yes
Parent organization: CHARLES DREW HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name: Ms. Tarsha Denise Jackson
Title: Chief Financial Officer
Phone: (402) 457-1215

Specialties & licenses 8

Specialty (taxonomy)	Code	State	Primary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103T00000X
Community Health Clinic/Center	261QC1500X	NE
Federally Qualified Health Center (FQHC)	261QF0400X	NE	Primary
Community Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LC1500X
Community Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LC1500X	NE

Addresses

Primary practice location

5100 Florence Blvd
Omaha, NE 68110-5346

Mailing address

PO Box 30019
2915 Grant Street
Omaha, NE 68111-3863
Phone (402) 451-3553

Other identifiers 2

Identifier	Type	State	Issuer
100262764-00	Other	NE	NON-FQHC
100262763-00	Medicaid	NE

Other names 1

Charles Drew Health Center, Inc at Florence Tower Other name

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN 281824

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name: CHARLES DREW HEALTH CENTER INC
Certification status: Active
Provider type (POS): Federally qualified health center
Participating since: Nov 30, 2012
Last certification: Nov 30, 2012
Ownership / control type: For profit – partnership
Facility address: 5100 Florence Blvd
Omaha, NE 68110

National Provider Directory

Part of: Benson Community Health Center

NPI Registry JSON

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

{
    "created_epoch": "1345593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1952659930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30019",
            "address_2": "2915 GRANT STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 FLORENCE BLVD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681105346",
            "telephone_number": "402-457-1241",
            "fax_number": "402-457-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER, INC",
        "enumeration_date": "2012-08-22",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": null,
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON-FQHC",
            "identifier": "100262764-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100262763-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Health Center, Inc at Florence Tower",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc at Florence Tower",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.