| Lower Lights Christian Health Center, Inc. | |
|
1160 W Broad St Columbus OH 43222-1317 | |
| (614) 274-1455 | |
| (614) 274-1433 |
| Full Name | Lower Lights Christian Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1160 W Broad St, Columbus, Ohio |
| Authorized Official Name and Position | Tracy Cloud (CEO) |
| Authorized Official Contact | 6142741455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lower Lights Christian Health Center, Inc. 1160 W Broad St Columbus OH 43222-1352 Ph: (614) 274-1455 | Lower Lights Christian Health Center, Inc. 1160 W Broad St Columbus OH 43222-1317 Ph: (614) 274-1455 |
| NPI Number | 1033455209 |
|---|---|
| Provider Enumeration Date | 12/17/2012 |
| Last Update Date | 03/11/2022 |
| Medicare PECOS PAC ID | 5193794188 |
|---|---|
| Medicare Enrollment ID | O20140702000762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033455209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Terresa L Hawthorne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104891944 PECOS PAC ID: 7113902701 Enrollment ID: I20040618001132 |
| Provider Name | Mary Angela Gregg |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1801098348 PECOS PAC ID: 9830135193 Enrollment ID: I20050708000097 |
| Provider Name | Jacqueline G Davis |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1902885734 PECOS PAC ID: 5496750499 Enrollment ID: I20060926000312 |
| Provider Name | Jennifer J Hartman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811008840 PECOS PAC ID: 5193721538 Enrollment ID: I20061009000174 |
| Provider Name | Elezabeth M Young |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1194933077 PECOS PAC ID: 6406941806 Enrollment ID: I20071001000218 |
| Provider Name | Karen M O'brien |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730365875 PECOS PAC ID: 3577647841 Enrollment ID: I20080226000055 |
| Provider Name | Cristina P Chandler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861774929 PECOS PAC ID: 0648419069 Enrollment ID: I20130615000161 |
| Provider Name | Amanda E Ransdell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1093147845 PECOS PAC ID: 3173767191 Enrollment ID: I20130912000846 |
| Provider Name | Susan J Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720492549 PECOS PAC ID: 2668691213 Enrollment ID: I20140915001384 |
| Provider Name | Ashley Degutis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003212382 PECOS PAC ID: 2860710688 Enrollment ID: I20150407001981 |
| Provider Name | Raina Theiss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588069595 PECOS PAC ID: 5698094753 Enrollment ID: I20150512001921 |
| Provider Name | Emanuel Ransom Dolph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821357062 PECOS PAC ID: 0648400457 Enrollment ID: I20150727000979 |
| Provider Name | Karen Ann Barnhart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356724918 PECOS PAC ID: 4486961752 Enrollment ID: I20150918000750 |
| Provider Name | Alison J Nolte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669849469 PECOS PAC ID: 2365751948 Enrollment ID: I20151021002741 |
| Provider Name | Amber Dawn Boice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639623465 PECOS PAC ID: 0941595169 Enrollment ID: I20160825002902 |
| Provider Name | Sarah Channell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508217589 PECOS PAC ID: 2365725918 Enrollment ID: I20170207000134 |
| Provider Name | Elizabeth Kimball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649416991 PECOS PAC ID: 6406913623 Enrollment ID: I20170216001079 |
| Provider Name | Elizabeth Drake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962928333 PECOS PAC ID: 9032484175 Enrollment ID: I20170929000326 |
| Provider Name | Christine Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366965600 PECOS PAC ID: 9638444607 Enrollment ID: I20171002003549 |
| Provider Name | Heather Crockett-miller |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1124287123 PECOS PAC ID: 0446525281 Enrollment ID: I20171004003543 |
| Provider Name | Amanda Adepalli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730442245 PECOS PAC ID: 5698914372 Enrollment ID: I20171213000986 |
| Provider Name | Estefania Erb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699283499 PECOS PAC ID: 5698036267 Enrollment ID: I20180221002585 |
| Provider Name | Amanda Viles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922590371 PECOS PAC ID: 0244580009 Enrollment ID: I20180829002371 |
| Provider Name | Kyle Edwin Pfeifer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942772249 PECOS PAC ID: 3577800275 Enrollment ID: I20190201002019 |
| Provider Name | Sarah M Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679982193 PECOS PAC ID: 7911126768 Enrollment ID: I20190802002241 |
| Provider Name | Ben Seagren |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407233364 PECOS PAC ID: 2264736768 Enrollment ID: I20200107002994 |
| Provider Name | Devindrjit Jordan Singh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144701012 PECOS PAC ID: 0941635114 Enrollment ID: I20200115003384 |
| Provider Name | Emily S Mowry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336620566 PECOS PAC ID: 4587090071 Enrollment ID: I20200131000664 |
| Provider Name | Crystal Burnfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093294597 PECOS PAC ID: 8820429087 Enrollment ID: I20200504001923 |
| Provider Name | Olivia Valentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023639796 PECOS PAC ID: 5395163513 Enrollment ID: I20200918002395 |
| Provider Name | Pamela Nkwenti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760660112 PECOS PAC ID: 5294962387 Enrollment ID: I20201130002838 |
| Provider Name | Clarissa Jane Dilaveris |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1275168411 PECOS PAC ID: 9931520293 Enrollment ID: I20201203002858 |
| Provider Name | Alan R Bock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407177835 PECOS PAC ID: 4981873254 Enrollment ID: I20210309001792 |
| Provider Name | Evan Kyo Tamura |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558724559 PECOS PAC ID: 4880924851 Enrollment ID: I20210428001117 |
| Provider Name | Katie C Worsham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629662986 PECOS PAC ID: 1759784861 Enrollment ID: I20210727003835 |
| Provider Name | Elizabeth Schwieterman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366111387 PECOS PAC ID: 3274930557 Enrollment ID: I20210929002346 |
| Provider Name | Jori Blume |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083017859 PECOS PAC ID: 8921406307 Enrollment ID: I20211015001037 |
| Provider Name | Amber Everett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164181996 PECOS PAC ID: 1951792001 Enrollment ID: I20211227001360 |
| Provider Name | John R Boudouris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861039430 PECOS PAC ID: 4880072966 Enrollment ID: I20220601001969 |
| Provider Name | Hannah Hampton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760125603 PECOS PAC ID: 5890170831 Enrollment ID: I20220912003566 |
| Provider Name | Mayra E Crotty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760984694 PECOS PAC ID: 9335524974 Enrollment ID: I20220916002288 |
| Provider Name | Myles D. Spar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013028307 PECOS PAC ID: 3072597327 Enrollment ID: I20230203001761 |
| Provider Name | Michelle Nemer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902244130 PECOS PAC ID: 1456585637 Enrollment ID: I20240222002407 |
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