NPIMap

Organization Active NPI

Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • New London, CT
National Provider Identifier
1982889309
Registry record updated Oct 30, 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
1 Shaws CV
New London, CT 06320-4902
Phone
(860) 447-8304
Fax
(860) 443-8720
NPI assigned
Jan 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 0229 CT
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X 0229 CT
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1 Shaws CV
New London, CT 06320-4902

Mailing address

575 Main St FL 2
Attn: Credentialing DPT
Middletown, CT 06457-2845
Phone (860) 347-6971

Other identifiers 3

IdentifierTypeStateIssuer
004236338MedicaidCT
004236346MedicaidCT
004236354MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080219000133 CT Part A Provider - Federally Qualified Health Center (FQHC) 0547169138 Practice locations: New London, CT

Federally qualified health center certification: CCN 071839

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
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 1, 1997 in CT
Enrollment address
1 Shaws CV
New London, CT 63204902

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center30 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 12

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 May 1, 1992
Mark Bonney Individual Corporate Director May 1, 1992
Angela Anthony Individual Corporate Director May 1, 1992
Mark Masselli Individual 5% Or Greater Direct Ownership InterestPresident/Ceo May 1, 1972 100%
Corporate OfficerPresident/Ceo May 1, 1972 100%
Corporate Director May 1, 1992
W-2 Managing Employee May 1, 1992
Catherine O'Brien Individual Corporate OfficerDelegated Official Apr 1, 2011
Bain Patrie Individual Corporate OfficerDelegated Official Apr 1, 2011
Donald J Case Individual Corporate Director May 1, 1992
David Vance Individual Corporate Director May 1, 1992
Aida Heredia Individual Corporate Director May 1, 1992
Terry Danaher Individual Corporate Director May 1, 1992
Maragaret Flinter Individual 5% Or Greater Direct Ownership InterestSVP/Clinical Director May 1, 1992 100%
Corporate OfficerSVP/Clinical Director May 1, 1992 100%
Corporate Director May 1, 1992 100%
W-2 Managing Employee May 1, 1992 100%
Stewart R Joslin Individual Corporate Director May 1, 1992
W-2 Managing Employee May 1, 1992

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.

NPI Registry JSON

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

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351555200000",
    "number": "1982889309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 MAIN ST FL 2",
            "address_2": "ATTN: CREDENTIALING DPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572845",
            "telephone_number": "860-347-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHAWS CV",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204902",
            "telephone_number": "860-447-8304",
            "fax_number": "860-443-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2012-10-30",
        "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": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "0229",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "0229",
            "primary": false
        },
        {
            "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": "004236338",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236354",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.