NPIMap

Organization Active NPI

Circle the City

Doing business as Circle the City Mobile Clinic II

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1952948804
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CIRCLE THE CITY
Doing business as
Circle the City Mobile Clinic II
Practice address
3522 N 3Rd Ave
Phoenix, AZ 85013-3903
Phone
(602) 776-7676
Fax
(602) 776-3002
NPI assigned
Dec 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
William Ellert, MD
Title
Cmo
Phone
(602) 776-0776

Specialties & licenses 1

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

Addresses

Primary practice location

3522 N 3Rd Ave
Phoenix, AZ 85013-3903

Mailing address

300 W Clarendon Ave Ste 200
Phoenix, AZ 85013-3422
Phone (602) 776-0776

Other names 1

  • Circle the City Mobile Clinic II Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150813012502 AZ Part A Provider - Federally Qualified Health Center (FQHC) 3971824442 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952948804. Details of each certification follow.

Federally qualified health center certification: CCN 031926

Legal name
CIRCLE THE CITY
Doing business as
PARSONS FAMILY HEALTH CENTER AT CIRCLE THE CITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2015
Last certification
Aug 4, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 2008 in AZ
Enrollment address
3522 N 3Rd Ave
Phoenix, AZ 85013-3903

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Circle the City13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
James T Nathan Individual Corporate DirectorDirector Mar 23, 2015
Kelli Kathleen Smith Individual Corporate Officer Jan 1, 2022
Roy Pringle Individual Corporate DirectorBoard Treasurer Oct 24, 2016
Adele Marie O Sullivan Individual Corporate Director Jul 30, 2018
Michael Zenobi Individual Corporate OfficerChief Financial Officer Dec 1, 2020 33%
W-2 Managing EmployeeCfo Dec 1, 2020 33%
Operational/Managerial ControlCfo Dec 1, 2020 33%
Circle the City Organization, Phoenix, AZ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 12, 2015 100%
Ryan Andrew Odgers Individual Corporate Officer Jan 1, 2022
Thomas Betlach Individual Corporate Director Jan 1, 2022
Kim Despres Individual Corporate OfficerChief Executive Officer Dec 1, 2020 33%
W-2 Managing EmployeeChief Executive Officer Dec 1, 2020 33%
Operational/Managerial ControlChief Executive Officer Dec 1, 2020 33%
Clayton Foster Individual Corporate Director Jan 1, 2022
Marc L Leib Individual Corporate DirectorDirector Oct 24, 2016
Kathy Stein Individual Corporate Director May 22, 2017
Petrona Zickgraf Individual W-2 Managing EmployeeAssistant Controller Dec 1, 2020 23%
Lori Ann McClelland Individual Corporate DirectorDirector Sep 27, 2010
Danielle Millard Individual Corporate Officer Jan 1, 2022
Jaxinta Shaffer Individual Corporate Officer Jan 1, 2022
Marion K. Kelly Individual Corporate DirectorDirector Oct 24, 2016

Owners & managing parties with NPI records 8

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

  • Circle the City

    dba Circle the City Pharmacy

    • Community/Retail Pharmacy
    • Phoenix, AZ
    • NPI 1144093972

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Family Medicine Physician
    • Phoenix, AZ
    • NPI 1346588316

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City

    dba Circle the City Medical Respite Center, Downtown Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1346755295

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center - UMOM Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1447765474

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1487033247

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center, Downtown Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1548775570

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1932588795

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Ryan Andrew Odgers, M.D.
    • Orthopaedic Hand Surgery Physician
    • Phoenix, AZ
    • NPI 1891014049

    Corporate Officer

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1575936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1952948804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CLARENDON AVE STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133422",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 N 3RD AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133903",
            "telephone_number": "602-776-7676",
            "fax_number": "602-776-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE THE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "ELLERT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "602-776-0776",
        "authorized_official_credential": "MD"
    },
    "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": "Circle the City Mobile Clinic II",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Circle the City Mobile Clinic II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.