NPIMap

Organization Active NPI

Detroit Community Health Connection, Inc.

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1982611562
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION, INC.
Practice address
13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone
(313) 822-0900
Fax
(313) 822-0950
NPI assigned
Aug 3, 2006
Last updated
Jun 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

Name
Mr. Mahipal Rao Kakarala
Title
Cfo
Phone
(313) 821-2591

Specialties & licenses 1

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

Addresses

Primary practice location

13901 E Jefferson Ave
Detroit, MI 48215-2720

Mailing address

13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone (313) 821-2591

Other identifiers 2

IdentifierTypeStateIssuer
1992196MedicaidMI
1982611562OtherNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000067 MI Part B Supplier - Clinic/Group Practice 9234021148 Receives reassigned benefits from 23 practitioners
7 other NPIs on this enrollment
Practice locations: Detroit, MI
O20080626000326 MI Part A Provider - Federally Qualified Health Center (FQHC) 9234021148 Practice locations: Detroit, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982611562. Details of each certification follow.

Federally qualified health center certification: CCN 231802

Legal name
DETROIT COMMUNITY HEALTH CONNECTION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Aug 3, 1988 in MI
Enrollment address
13901 E Jefferson Ave
Detroit, MI 48215-2720

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Detroit Community Health Connection9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

611 Mlk Blvd
Detroit, MI 48201
Phone (313) 832-6300

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Patrick O Lindsey Individual Corporate DirectorBoard Secretary Oct 27, 2015
Hallistine Stewart Individual Corporate Director Oct 27, 2015
Derek Ware Individual Corporate Director Sep 13, 2024
W-2 Managing EmployeePresident & Ceo Sep 13, 2024
Crystal R Gardner-Martin Individual Corporate Director May 17, 2024
Henry Tokarz Individual Corporate Officer Mar 3, 2025
W-2 Managing EmployeeVice President & Cfo Mar 3, 2025
Henry C Conerway Individual Corporate DirectorVice Chairperson Jul 27, 2021
Linda J Bowie Individual Corporate Director Jul 27, 2021
Mable Jones Individual Corporate Director Feb 27, 2025
Patricia a Wilkerson-Uddyback Individual W-2 Managing EmployeeChief Medical Officer Feb 26, 2024
Gwendolyn J Scales Individual Corporate Director Nov 1, 2009
Thomas E Hardiman Individual Corporate Director Jul 27, 2021
Louise Guyton Individual Corporate DirectorBoard Treasurer Sep 25, 2003
Paul Bridgewater Individual Corporate DirectorBoard Chairperson Aug 28, 2007
Eric B Scott Individual Corporate Director Dec 1, 2024
Vanessa Holsey Individual Corporate Director Sep 1, 2024
Gregory a Jones Individual Corporate Director Oct 27, 2015

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Dr Sophie Womack Health CenterDetroit, MI, CCN 231937 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Woodward Corridor Family Medical CenterDetroit, MI, CCN 231936 Federally qualified health center Operational/Managerial Control (100%) Apr 18, 1997
Dr Feleta Wilson Health CenterDetroit, MI, CCN 231935 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Nolan Family Health CenterDetroit, MI, CCN 231934 Federally qualified health center Operational/Managerial Control Feb 11, 2004
Oscar Paskal Health CenterDetroit, MI, CCN 231015 Federally qualified health center Operational/Managerial Control Aug 11, 2011
Dr Peter Slaughter Health CenterDetroit, MI, CCN 231139 Federally qualified health center Operational/Managerial Control Dec 12, 2018

Owned or controlled facilities with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1982611562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-821-2591",
            "fax_number": "313-822-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-822-0900",
            "fax_number": "313-822-0950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "KAKARALA",
        "authorized_official_first_name": "MAHIPAL",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "313-821-2591",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992196",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1982611562",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.