NPIMap

Organization Active NPI

Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Norwalk, CT
National Provider Identifier
1972788321
Registry record updated Nov 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER INC
Practice address
49 Day St
Norwalk, CT 06854-4901
Phone
(203) 854-9292
Fax
(203) 854-9437
NPI assigned
Jan 4, 2008
Last updated
Nov 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2012

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

Authorized official

Name
Ms. Bain Patrie
Title
Credentialing Specialist
Phone
(860) 347-6971

Specialties & licenses 1

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

Addresses

Primary practice location

49 Day St
Norwalk, CT 06854-4901

Mailing address

575 Main St 2ND Floor
Attn: Credentialing DPT
Middletown, CT 06457-2718
Phone (860) 347-6971

Other identifiers 3

IdentifierTypeStateIssuer
004236346MedicaidCT
004236354MedicaidCT
004236338MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080219000170 CT Part A Provider - Federally Qualified Health Center (FQHC) 0547169138 1 other NPI on this enrollment
Practice locations: Norwalk, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972788321. Details of each certification follow.

Federally qualified health center certification: CCN 071843

Legal name
COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2008
Last certification
Mar 31, 2008
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 1, 1972 in CT
Enrollment address
49 Day St
Norwalk, CT 68544901

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center Inc30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Gary Reid Individual Corporate Director Jun 1, 2007
Mark Bonney Individual Corporate Director Jun 1, 2007
Angela Anthony Individual Corporate Director Jun 1, 2007
Mark Masselli Individual Corporate OfficerPresident Ceo May 1, 1972 100%
Donald J Case Individual Corporate Director Jun 1, 2007
David Vance Individual Corporate Director Jun 1, 2007
Terry Danaher Individual Corporate Director Jun 1, 2007
Maragaret Flinter Individual Corporate OfficerSVP/Clinical Director Nov 1, 1980
W-2 Managing EmployeeSVP/Clinical Director Nov 1, 1980
Jill Maconi Individual Corporate Director Dec 15, 2008

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Center of DanburyDanbury, CT, CCN 071849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2000
Community Health Center of EnfieldEnfield, CT, CCN 071850 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2000

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1199404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1972788321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MAIN ST 2ND FLOOR",
            "address_2": "ATTN: CREDENTIALING DPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572718",
            "telephone_number": "860-347-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 DAY ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068544901",
            "telephone_number": "203-854-9292",
            "fax_number": "203-854-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-04",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "PATRIE",
        "authorized_official_first_name": "BAIN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "860-347-6971",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236354",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236338",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.