NPIMap

Organization Active NPI

Atlanticare Health Services Inc.

Doing business as AtlantiCare Mission Health Care Galloway

  • Federally Qualified Health Center (FQHC)
  • Galloway, NJ
National Provider Identifier
1043700495
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ATLANTICARE HEALTH SERVICES INC.
Doing business as
AtlantiCare Mission Health Care Galloway
Practice address
54 W Jimmie Leeds Rd
Galloway, NJ 08205-9438
Phone
(609) 404-7300
Fax
(609) 572-6008
NPI assigned
May 11, 2018
Last updated
Mar 18, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ATLANTICARE HEALTH SERVICES INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Authorized official

Name
Ms. Sandy Festa
Title
Exec Dir FQHC
Phone
(609) 572-6051

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NJ
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

54 W Jimmie Leeds Rd
Galloway, NJ 08205-9438

Mailing address

1401 Atlantic Ave Ste 1125
Atlantic City, NJ 08401-7001
Phone (609) 572-6051

Other names 1

  • AtlantiCare Mission Health Care Galloway Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040719001204 NJ Part B Supplier - Clinic/Group Practice 7911810916 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pleasantville, NJ; Galloway, NJ; Egg Harbor Township, NJ; Atlantic City, NJ
O20220512001417 NJ Part A Provider - Federally Qualified Health Center (FQHC) 7911810916 Practice locations: Galloway, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043700495. Details of each certification follow.

Federally qualified health center certification: CCN 311949

Legal name
ATLANTICARE HEALTH SERVICES, INC.
Doing business as
ATLANTICARE MISSION HEALTH CARE GALLOWAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2022
Last certification
May 13, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
54 W Jimmie Leeds Rd
Ste 8
Galloway, NJ 82059438

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2152726Atlanticare Health Services Galloway54 West Jimmie Leeds Road, Galloway Township, NJ 08205Certificate of waiverMar 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Atlantic Urgent Care Ce16 organizations share this tax ID, including this one
Part of
Atlantic Urgent Care Ce

Other organizations with this tax ID 15

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

View all 15

Locations

1401 Atlantic Ave
Ste 2200
Atlantic City, NJ 08401
Phone (609) 572-6043

1401 Atlantic Ave
Ste 2500
Atlantic City, NJ 08401
Phone (609) 347-0052

1401 Atlantic Ave
Ste 2600
Atlantic City, NJ 08401
Phone (609) 441-8036

65 W Jimmie Leeds Rd
#J
Pomona, NJ 08240

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
Ronald Caplan Individual Corporate DirectorBoard Member Apr 1, 2021
Perry Mays Individual Corporate DirectorBoard Member Apr 1, 2021
Felicia Banks Individual Corporate DirectorBoard Member Apr 1, 2021
Jerrold H Savoy Individual Corporate DirectorBoard Member Apr 1, 2021
Rosalind Kincaid Individual Corporate DirectorChairperson Apr 1, 2021
Celestine Perry Individual Corporate DirectorBoard Member Apr 1, 2021
Mary Ellen Rochelle Individual Corporate DirectorBoard Member Apr 1, 2021
Jose Claro Individual Corporate DirectorBoard Member Apr 1, 2021
Christopher C Apgar Individual Corporate OfficerCfo Apr 1, 2021
W-2 Managing EmployeeCfo Apr 1, 2021
Walter Stein Individual Corporate DirectorBoard Member Apr 1, 2021
Sandra Garrett Individual Corporate DirectorBoard Member Apr 1, 2021
Sheila Hughes Individual Corporate DirectorBoard Member Apr 1, 2021

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Select Specialty Hospital -Atlantic CityAtlantic City, NJ, CCN 312023 Hospital 5% Or Greater Direct Ownership Interest (20%)
Limited Partnership Interest (20%)		 Apr 2, 2011
Aug 1, 2009
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311008 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Atlanticare Health Services, Inc.Pleasantville, NJ, CCN 311014 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2024
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311015 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2022
Atlanticare Health Services, Inc.Egg Harbor Township, NJ, CCN 311017 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023

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 92

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 92

NPI Registry JSON

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1043700495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 ATLANTIC AVE STE 1125",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "084017001",
            "telephone_number": "609-572-6051",
            "fax_number": "609-572-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 W JIMMIE LEEDS RD",
            "city": "GALLOWAY",
            "state": "NJ",
            "postal_code": "082059438",
            "telephone_number": "609-404-7300",
            "fax_number": "609-572-6008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTICARE HEALTH SERVICES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTICARE HEALTH SERVICES INC.",
        "enumeration_date": "2018-05-11",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "FESTA",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "EXEC DIR FQHC",
        "authorized_official_telephone_number": "609-572-6051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AtlantiCare Mission Health Care Galloway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galloway, NJ

Sources for this page

Verify at the official NPI Registry.