NPIMap

Organization Active NPI

Community Health & Wellness Partners of Logan County

Doing business as Indian Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Russells Point, OH
National Provider Identifier
1962828293
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Doing business as
Indian Lake Community Health Center
Practice address
8200 State Route 366
Suite No. 1
Russells Point, OH 43348-9670
Phone
(937) 599-1411
Fax
(937) 599-4128
NPI assigned
Mar 11, 2014
Last updated
Aug 14, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Authorized official

Name
Tara D Bair
Title
President/Ceo
Phone
(937) 887-1013

Specialties & licenses 1

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

Addresses

Primary practice location

8200 State Route 366
Suite No. 1
Russells Point, OH 43348-9670

Mailing address

212 E Columbus Ave Ste 1
Bellefontaine, OH 43311-2033
Phone (937) 599-1411

Other names 1

  • Indian Lake Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140326001589 OH Part B Supplier - Clinic/Group Practice 8022247469 Receives reassigned benefits from 30 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Liberty, OH; Urbana, OH; Saint Paris, OH; Russells Point, OH; De Graff, OH; Bellefontaine, OH; Lewistown, OH
O20140519002338 OH Part A Provider - Federally Qualified Health Center (FQHC) 8022247469 1 other NPI on this enrollment
Practice locations: Russells Point, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962828293. Details of each certification follow.

Federally qualified health center certification: CCN 361046

Legal name
COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 20, 2014
Last certification
May 20, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 6, 2012 in OH
Enrollment address
8200 State Route 366
Ste 1
Russells Point, OH 43348-9670

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Wellness17 organizations share this tax ID, including this one
Part of
Community Health Wellness

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kyle Springs Individual Corporate DirectorSecretary Nov 2, 2017
Lydia Hess Individual Corporate DirectorDirector Jun 1, 2023
Becky Martin Individual Corporate DirectorDirector Mar 3, 2022
Jackie Prater Individual Corporate DirectorDirector May 5, 2022
Tara D Bair Individual Corporate OfficerCeo Jun 6, 2012
Corporate DirectorCeo Jun 6, 2012
W-2 Managing EmployeeCeo Jun 6, 2012
Steven R Toney Individual Corporate DirectorMedical Director Jun 13, 2022
Kelli Bader Individual Corporate DirectorDirector Jun 2, 2022
Neil Rhodes Individual Corporate DirectorDirector Jun 2, 2022
Elizabeth McClure Individual Corporate DirectorSecretary Nov 2, 2017
Sarah Warren Individual Corporate DirectorDirector Mar 3, 2022
Mark Gibson Individual Corporate DirectorBoard Member Jul 13, 2019
Marcia Bailey Individual Corporate DirectorDirector Jun 1, 2023
Kyle Lentz Individual Corporate DirectorChair Aug 1, 2019
Ryan Berry Individual Corporate DirectorDirector Apr 4, 2025
Le-Anne Fuson Individual Corporate DirectorDirector Jun 6, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1962828293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 E COLUMBUS AVE STE 1",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433112033",
            "telephone_number": "937-599-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 STATE ROUTE 366",
            "address_2": "SUITE NO. 1",
            "city": "RUSSELLS POINT",
            "state": "OH",
            "postal_code": "433489670",
            "telephone_number": "937-599-1411",
            "fax_number": "937-599-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH & WELLNESS PARTNERS OF LOGAN COUNTY",
        "enumeration_date": "2014-03-11",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A",
        "authorized_official_last_name": "BAIR",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "937-887-1013"
    },
    "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": "Indian Lake Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russells Point, OH

Sources for this page

Verify at the official NPI Registry.