NPIMap

Organization Active NPI

Charles Drew Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1962089391
Registry record updated Mar 24, 2021
On 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
5920 Maple St
Omaha, NE 68104-4102
Phone
(402) 457-1200
Fax
(402) 939-0916
NPI assigned
Mar 24, 2021
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Authorized official

Name
Tarsha Jackson
Title
Chief Financial Officer
Phone
(402) 457-1215

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5920 Maple St
Omaha, NE 68104-4102

Mailing address

PO Box 11609
Omaha, NE 68111-0609
Phone (402) 457-1200

Other names 1

  • Teen and Young Adult Center at Benson Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211118001431 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

Federally qualified health center certification: CCN 281857

Legal name
CHARLES DREW HEALTH CENTER INC
Doing business as
TEEN & YOUNG ADULT HEALTH CENTER AT BENSON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2021
Last certification
Nov 18, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1984 in NE
Enrollment address
5920 Maple St
Omaha, NE 68104-4102

Other NPIs with the same Medicare PAC ID 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2227202Teen & Young Adult Health Center at Benson5920 Maple Street, Omaha, NE 68104Provider-performed microscopyJun 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Benson Community Health Center19 organizations share this tax ID, including this one
Part of
Benson Community Health Center

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Julieta Clarke Individual Corporate Director May 1, 2021
Kenny McMorris Individual Corporate Director Aug 3, 2009
Eric Payne Individual Corporate Director May 1, 2021
Elizabeth Campbell Individual Corporate Director May 1, 2021
Patricia Brown Individual Corporate Director May 1, 2021
W-2 Managing Employee May 1, 2021
Andy Lanik Individual Corporate Director May 1, 2021
Richard L Brown Individual Corporate Director May 1, 2021
Mike Saklar Individual Corporate Director May 1, 2021
Tarsha Jackson Individual Corporate Director May 12, 2014
Rick Bell Individual Corporate Director May 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616544000000",
    "number": "1962089391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11609",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681110609",
            "telephone_number": "402-457-1200",
            "fax_number": "402-939-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 MAPLE ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681044102",
            "telephone_number": "402-457-1200",
            "fax_number": "402-939-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER, INC.",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teen and Young Adult Center at Benson",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.