NPIMap

Organization Active NPI

Peoples Community Health Clinic, Inc

Doing business as Success Street - East High School

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IA
National Provider Identifier
1952917049
Registry record updated Sep 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEOPLES COMMUNITY HEALTH CLINIC, INC
Doing business as
Success Street - East High School
Practice address
214 High St
Waterloo, IA 50703-3908
Phone
(319) 433-2446
NPI assigned
Sep 23, 2020
Last updated
Sep 23, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
PEOPLES COMMUNITY HEALTH CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2020

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

Authorized official

Name
Beth White
Title
HR Administrator
Phone
(319) 874-3000

Specialties & licenses 1

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

Addresses

Primary practice location

214 High St
Waterloo, IA 50703-3908

Mailing address

905 Franklin St
Waterloo, IA 50703-4407
Phone (319) 874-3000

Other identifiers 2

IdentifierTypeStateIssuer
0076372MedicaidIA
15689OtherIAWELLMARK BCBS

Other names 1

  • Success Street - East High School Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@peoples-clinic.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000493 IA Part B Supplier - Clinic/Group Practice 6406746668 Receives reassigned benefits from 45 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, IA; Traer, IA; Waterloo, IA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Peoples Community HLTH

Locations

214 High St
Waterloo, IA 50703
Phone (319) 277-1990

Practitioners & affiliated clinicians

Practitioners 2

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": "1600819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600819200000",
    "number": "1952917049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 FRANKLIN ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507034407",
            "telephone_number": "319-874-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 HIGH ST",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507033908",
            "telephone_number": "319-433-2446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEOPLES COMMUNITY HEALTH CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEOPLES COMMUNITY HEALTH CLINIC, INC",
        "enumeration_date": "2020-09-23",
        "last_updated": "2020-09-23",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "BETH",
        "authorized_official_title_or_position": "HR ADMINISTRATOR",
        "authorized_official_telephone_number": "319-874-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076372",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "15689",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@peoples-clinic.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "214 High St",
            "city": "Waterloo",
            "state": "IA",
            "country_code": "US",
            "postal_code": "507033908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Success Street - East High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.