NPIMap

Organization Active NPI

Third Street Community Clinic Inc

Doing business as Five Points Primary Care

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
National Provider Identifier
1972053452
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC INC
Doing business as
Five Points Primary Care
Practice address
200 Park Ave W
Mansfield, OH 44902-1608
Phone
(419) 522-2239
Fax
(419) 525-6723
NPI assigned
Oct 10, 2016
Last updated
May 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

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

Addresses

Primary practice location

200 Park Ave W
Mansfield, OH 44902-1608

Mailing address

1404 Park Ave W
Ste 2
Mansfield, OH 44906-2633
Phone (419) 522-6191

Other names 1

  • Five Points Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161102000963 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Mansfield, OH
O20161212001804 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 21 practitioners
Practice locations: Mansfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972053452. Details of each certification follow.

Federally qualified health center certification: CCN 361120

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
FIVE POINTS PRIMARY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 25, 2016
Last certification
Oct 25, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
200 Park Ave W
Mansfield, OH 44902-1608

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Brett Edward Toward Individual Corporate OfficerCmo Jul 26, 2021
Corporate DirectorCmo Jul 26, 2021
W-2 Managing EmployeeCmo Jul 26, 2021
Barbara Sullinger Individual Corporate OfficerCfo Jul 26, 2021
Corporate DirectorCfo Jul 26, 2021
W-2 Managing EmployeeCfo Jul 26, 2021
Susan K Baker Individual Corporate DirectorBoard Member Jun 1, 2013
James Dolan Individual Corporate DirectorBoard Member Jul 26, 2021
Dorothy Stratton Individual Corporate DirectorBoard Member Jul 26, 2021
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Alexander Goff Individual Corporate DirectorBoard Member Apr 21, 2022
Khushwant Pittenger Individual Corporate DirectorBoard Member Jul 26, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Amber Wertman Individual Corporate DirectorBoard Member Jul 26, 2021
Cody Albert Individual Corporate DirectorBoard Member Jul 26, 2021
Peggy S Anderson Individual Corporate OfficerCeo Jul 26, 2021
Corporate DirectorBoard Member - P Jul 26, 2021
W-2 Managing EmployeeCeo Jul 26, 2021
Javar Jackson Individual Corporate OfficerCoo Jul 26, 2021
Corporate DirectorCoo Jul 26, 2021
W-2 Managing EmployeeCoo Jul 26, 2021

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 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1972053452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W",
            "address_2": "STE 2",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062633",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449021608",
            "telephone_number": "419-522-2239",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "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": "Five Points Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Five Points Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.