NPIMap

Organization Active NPI

Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
National Provider Identifier
1962496679
Registry record updated Jun 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE, INC.
Practice address
1351 W Central Park Ave
Davenport, IA 52804-1853
Phone
(563) 421-4244
Fax
(563) 421-4285
NPI assigned
Sep 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2010

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

Authorized official

Name
Thomas J Bowman
Title
Ceo
Phone
(563) 336-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

1351 W Central Park Ave
Davenport, IA 52804-1853

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other identifiers 7

IdentifierTypeStateIssuer
I12619OtherIAINDEPENDANT LAB
16D1035713OtherIACLIA #
0418517MedicaidIA
113373OtherIAUNITED HEALTHCARE
39110OtherIAIA BC/BS GROUP#
8122859OtherILIL BC/BS GROUP #
CP8565OtherIARAILROAD MEDICARE GROUP #

Other names 1

  • Community Health Care - Regional Virology Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000776 IA Part B Supplier - Clinic/Group Practice 9830008895 Receives reassigned benefits from 78 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, IA; Muscatine, IA; Clinton, IA

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

1351 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276560000000",
    "number": "1962496679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 W CENTRAL PARK AVE",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528041853",
            "telephone_number": "563-421-4244",
            "fax_number": "563-421-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2010-06-15",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-336-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDANT LAB",
            "identifier": "I12619",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "16D1035713",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0418517",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "113373",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BC/BS GROUP#",
            "identifier": "39110",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BC/BS GROUP #",
            "identifier": "8122859",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CP8565",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Care - Regional Virology",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; 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.