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Christ Community Health Services, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Memphis, TN

NPI 1962020446 · NPPES record last updated Dec 6, 2024

Key facts

NPI
1962020446
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 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
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 14

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

Other NPIs with the same Medicare PAC ID 12

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

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 61

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TN

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
Other · Non-profit
Incorporated
Jun 1, 1995 in TN
Enrollment address
4480 Westmont Rd
Memphis, TN 38109-5646

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 Officer
Ceo		 Jan 1, 2017
W-2 Managing Employee
Ceo		 Jan 1, 2017

Medicare enrollment records

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

National Provider Directory

Locations

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

Specialties & licenses

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

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

Other providers in Memphis, TN

All providers in Memphis, TN · Federally Qualified Health Center (FQHC) in Tennessee

Sources for this page

Verify at the official NPI Registry.