| Addresses | Main Address | Update | Change Request |
2814 14th Ave SE
Ruskin, FL 33570-5471 |
313 S. Lakewood Dr.
Brandon, FL 33511 | 3/17/2025 10:00 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2024 11:55:25 AM | 2/14/2025 10:20:01 AM | 2/14/2025 10:20 AM |
| Contacts | Primary Contact | Update | Group Change Request | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | Peguero, Miosotis
Analyst – Finance & Pharmacy Compliance
Suncoast Community Health Centers, Inc.
8133497998 | 3/28/2024 10:03 AM |
| Contacts | Primary Contact | Update | Recertification | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Clinic Administrator
Suncoast Community Health Centers, Inc.
8133314921 | 2/7/2024 11:55 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 9:52:27 AM | 2/7/2024 11:55:25 AM | 2/7/2024 11:55 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Leone, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 5/23/2023 12:41 PM |
| Details | Entity Subname | Update | Change Request | Suncoast Mobile Dental Van | Suncoast Mobile Dental Bus I | 4/25/2023 7:43 PM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2022 3:24:30 PM | 1/30/2023 9:52:27 AM | 1/30/2023 9:52 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | Wrightson, Natalie Kaye
Special Projects Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 6/23/2022 9:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2021 9:22:31 AM | 2/1/2022 3:24:30 PM | 2/1/2022 3:24 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | FL | 2/3/2021 9:22 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 2:36:26 PM | 2/3/2021 9:22:31 AM | 2/3/2021 9:22 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 3:45:20 PM | 1/28/2020 2:36:26 PM | 1/28/2020 2:36 PM |
| Contacts | Primary Contact | Update | Change Request | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | Wrightson, Natalie Kaye
Pharmacy Compliance and Financial Analyst
Suncoast Community Health Centers, Inc.
8133497998 | 9/25/2019 11:54 AM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2018 2:23:53 PM | 1/30/2019 3:45:20 PM | 1/30/2019 3:45 PM |
| Details | Last Recertification Date | Update | Recertification | 2/10/2017 12:00:00 AM | 2/19/2018 2:23:53 PM | 2/19/2018 2:23 PM |
| Contacts | Authorizing Official | Update | | Herremans, Bradley
CEO
8136536268 | Herremans, Bradley
CEO
Suncoast Community Health Centers, Inc.
8136536268 | 1/9/2018 11:45 AM |
| Contacts | Primary Contact | Update | | Hunt, Jeff
Pharmacy Director
8133497959 | Hunt, Jeff
Pharmacy Director
Suncoast Community Health Centers, Inc
8133497959 | 1/9/2018 9:54 AM |
| Contacts | Primary Contact | Insert | | | Hunt, Jeff
Pharmacy Director
8133497959 | 8/9/2017 11:03 AM |
| Contacts | Authorizing Official | Insert | | | Herremans, Bradley
CEO
8136536268 | 8/9/2017 11:03 AM |
| Contacts | Signed By | Insert | | | Rodriguez, Robert
CFO
8133497563 | 6/16/2017 1:59 PM |
| Addresses | Main Address | Insert | | |
2814 14th Ave SE
Ruskin, FL 33570-5471 | 2/10/2017 11:25 AM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/10/2017 12:00:00 AM | 2/10/2017 11:25 AM |
| Details | Last Recertification Date | Update | | 2/3/2015 12:00:00 AM | 2/12/2016 12:00:00 AM | 2/12/2016 11:48 AM |
| Addresses | Billing Address | Insert | | | Suncoast Community Health Centers, Inc.
P. O. Box 1349
Ruskin, FL 33575 | 2/3/2015 12:36 PM |
| Details | Last Recertification Date | Update | | 3/21/2014 12:00:00 AM | 2/3/2015 12:00:00 AM | 2/3/2015 12:36 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/21/2014 12:00:00 AM | 3/21/2014 10:21 PM |
| Details | Entity Name | Update | | SUNCOAST COMMUNITY HEALTH CENTERS, INC | SUNCOAST COMMUNITY HEALTH CENTERS, INC. | 3/21/2014 10:21 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/19/2013 10:49 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 11/8/2012 9:24 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 029557408 | 11/8/2012 9:24 AM |
| Medicaid Billing | Medicaid: State | Insert | | | FL | 11/8/2012 9:24 AM |
| Details | 340B ID | Update | | IS-FF-CH04175L | CH04175L | 8/29/2012 4:59 PM |
| Dates | Participating Approval Date | Update | | | 8/29/2012 12:00:00 AM | 8/29/2012 4:59 PM |
| Details | State | Update | | Pending | Active | 8/29/2012 4:59 PM |
| Dates | Start Date | Update | | | 10/1/2012 12:00:00 AM | 8/29/2012 4:59 PM |
| Details | 340B ID | Update | | ONLINE_REG | IS-FF-CH04175L | 8/17/2012 4:52 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1780994897 | 7/25/2012 12:46 PM |
| Details | Last Recertification Date | Insert | | | | 7/25/2012 12:46 PM |
| Details | Grant Number | Insert | | | H80CS00541 | 7/25/2012 12:46 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 7/25/2012 12:46 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/25/2012 12:46 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/25/2012 12:46 PM |
| Details | Medicare Provider Number | Insert | | | | 7/25/2012 12:46 PM |
| Details | Entity Name | Insert | | | SUNCOAST COMMUNITY HEALTH CENTERS, INC | 7/25/2012 12:46 PM |
| Details | Program Code | Insert | | | CH | 7/25/2012 12:46 PM |
| Details | Entity Subname | Insert | | | Suncoast Mobile Dental Van | 7/25/2012 12:46 PM |
| Dates | Participating Approval Date | Insert | | | | 7/25/2012 12:46 PM |
| Details | State | Insert | | | Pending | 7/25/2012 12:46 PM |
| Dates | Registration Date | Insert | | | 7/25/2012 12:00:00 AM | 7/25/2012 12:46 PM |
| Dates | Signed By Date | Insert | | | 7/25/2012 12:00:00 AM | 7/25/2012 12:46 PM |
| Dates | Start Date | Insert | | | | 7/25/2012 12:46 PM |
| Terminations | Termination Comments | Insert | | | | 7/25/2012 12:46 PM |
| Terminations | Termination Date | Insert | | | | 7/25/2012 12:46 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/25/2012 12:46 PM |
| Terminations | Termination Reason | Insert | | | | 7/25/2012 12:46 PM |