NPIMap

Organization Active NPI

Christ Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
National Provider Identifier
1962020446
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES, INC.
Practice address
4480 Westmont Rd
Memphis, TN 38109-5646
Phone
(901) 842-3160
Fax
(901) 842-2360
NPI assigned
Jul 10, 2020
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Specialties & licenses 1

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

Addresses

Primary practice location

4480 Westmont Rd
Memphis, TN 38109-5646

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 842-3160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20200920000008 TN Part A Provider - Federally Qualified Health Center (FQHC) 3870402084 Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962020446. Details of each certification follow.

Federally qualified health center certification: CCN 441007

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 27, 2020
Last certification
Oct 27, 2020
Ownership / control type
For profit – partnership
Organization structure
OtherNon-profit
Incorporated
Jun 1, 1995 in TN
Enrollment address
4480 Westmont Rd
Memphis, TN 38109-5646

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Shantelle N Leatherwood Individual Corporate OfficerCeo Jan 1, 2017
W-2 Managing EmployeeCeo Jan 1, 2017

NPI Registry JSON

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

{
    "created_epoch": "1594339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1962020446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 UNION AVENUE EXT STE 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124416",
            "telephone_number": "901-842-3160",
            "fax_number": "901-842-2360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 WESTMONT RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381095646",
            "telephone_number": "901-842-3160",
            "fax_number": "901-842-2360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-10",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-842-3160"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.