NPIMap

Organization Active NPI

Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
National Provider Identifier
1992750855
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0259 Issued in CT
Legal business name
CHARTER OAK HEALTH CENTER, INC.
Practice address
21 Grand St
Hartford, CT 06106-1541
Phone
(860) 550-7500
NPI assigned
May 22, 2006
Last updated
May 8, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Authorized official

Name
Tim Powers
Title
Chief Compliance Officer
Phone
(860) 550-7500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X 0259 CT Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0312 CT

Addresses

Primary practice location

21 Grand St
Hartford, CT 06106-1541

Mailing address

21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500

Other identifiers 1

IdentifierTypeStateIssuer
004236007MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20021210000011 CT Part A Provider - Federally Qualified Health Center (FQHC) 3870401078 Practice locations: Hartford, CT
O20040220000909 CT Part B Supplier - Clinic/Group Practice 3870401078 Receives reassigned benefits from 122 practitioners
Practice locations: Hartford, CT; Bloomfield, CT
O20200814000463 CT Part A Provider - Federally Qualified Health Center (FQHC) 3870401078 Practice locations: Hartford, CT

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1992750855. Details of each certification follow.

Federally qualified health center certification: CCN 071819

Legal name
CHARTER OAK HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 31, 1996
Last certification
Jul 31, 1996
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 22, 2002 in CT
Enrollment address
21 Grand St
Hartford, CT 61061541

Federally qualified health center certification: CCN 071948

Legal name
CHARTER OAK HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 14, 2020
Last certification
Aug 14, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 2002 in CT
Enrollment address
32 Grand St
Hartford, CT 61064658

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Locations

21 Grand St
Ste 100
Hartford, CT 06106

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
Tim Powers Individual Corporate OfficerChief Compliance Officer Jan 1, 2019
Corporate OfficerChief Compliance Officer Oct 1, 2015
Rashad C Collins Individual Corporate OfficerChief Operations Officer Aug 1, 2017
Sunil B Dcunha Individual Corporate OfficerChief Medical Officer Apr 1, 2018
Martin John Individual Corporate DirectorTreasurer, Board Member Jul 25, 2012
Ann Marie Patterson Individual Corporate Officer Dec 13, 2005
Silvia Goldman Individual Corporate OfficerChief Financial Officer Sep 1, 2018
Adrian R Wood Individual Corporate DirectorChairperson May 22, 2013
Joel Cruz Individual Corporate DirectorBoard Member Apr 24, 2013
Nichelle a Mullins Individual Corporate OfficerPresident & Chief Executive Officer Jan 25, 2012
Operational/Managerial ControlPresident & Chief Executive Officer Oct 1, 2015 100%
Veronica Barcelona Individual Corporate DirectorChairperson, Board of Directors Aug 23, 2023
Joy-Lynn Hardy Individual Corporate DirectorSecretary, Board of Directors Oct 25, 2023
Kimberly Evans Individual Corporate OfficerGeneral Counsel Aug 29, 2022
Vernette Townsend Individual Corporate OfficerPresident & Chief Executive Officer Jan 1, 2025 100%
Operational/Managerial ControlPresident & Chief Executive Officer Jan 1, 2025 100%

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 124

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 124

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1992750855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061541",
            "telephone_number": "860-550-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061541",
            "telephone_number": "860-550-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARTER OAK HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "860-550-7500"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "0259",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "0312",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236007",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.