NPIMap

Organization Active NPI

Greater Philadelphia Health Action, Inc.

Doing business as GPHA Hunting Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1063466068
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER PHILADELPHIA HEALTH ACTION, INC.
Doing business as
GPHA Hunting Park Health Center
Practice address
1999 W Hunting Park Ave
Philadelphia, PA 19140-2828
Phone
(215) 228-9300
Fax
(215) 228-9913
NPI assigned
May 22, 2006
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Authorized official

Name
D Tina Smith
Title
Provider Enrollment Spec.
Phone
(215) 925-2400

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Midwife 176B00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X
Podiatrist 213E00000X

Addresses

Primary practice location

1999 W Hunting Park Ave
Philadelphia, PA 19140-2828

Mailing address

1401 S 31St St
2ND Floor
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other identifiers 1

IdentifierTypeStateIssuer
1001374480020MedicaidPA

Other names 1

  • GPHA Hunting Park Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227000867 PA Part A Provider - Federally Qualified Health Center (FQHC) 9537064977 Practice locations: Philadelphia, PA
O20110602000389 PA Part B Supplier - Clinic/Group Practice 9537064977 Receives reassigned benefits from 242 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, PA; Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063466068. Details of each certification follow.

Federally qualified health center certification: CCN 391867

Legal name
GREATER PHILADELPHIA HEALTH ACTION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 1994
Last certification
May 17, 1994
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 20, 1970 in PA
Enrollment address
1999W Hunting Park Ave
Philadelphia, PA 19140-2828

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 11

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
39D2116988Gpha Hunting Park Health Center1999 W Hunting Park Avenue, Philadelphia, PA 19140Provider-performed microscopyAug 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Gpha Midwifery Services39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Claire a Washington Individual Corporate OfficerBoard Member Mar 1, 2001
Celeste Johns Individual Corporate DirectorReimbursement Director Jun 23, 2008
Janice a Smith Individual Corporate OfficerBoard Member Mar 1, 1979
Valerie E Tuck Individual Corporate OfficerMember Jan 1, 2015
Roger C Collins Individual Corporate OfficerBoard Member/Assistant Treasurer Mar 1, 1979
Stephen R Cox Individual Corporate OfficerBoard Member/Second Vice Person Mar 1, 2000
Royal E Brown Individual Corporate OfficerBoard Member/Chairperson Mar 1, 1988
Brian Clark Individual Corporate OfficerCeo, Executive Director Dec 13, 2017
Corporate DirectorCeo, Executive Director Dec 13, 2017
W-2 Managing EmployeeCeo, Executive Director Dec 13, 2017
Sandra Hawkins-Dorsey Individual Corporate OfficerSecretary Mar 1, 2004
Minnie Moore-Johnson Individual Corporate OfficerMember May 1, 2020
Flora M Castillo Individual Corporate OfficerBoard Member Mar 1, 2008
Linda W Powell Individual Corporate Officer Mar 1, 2004
Phyllis H Detwiler Individual Corporate OfficerBoard Member Mar 1, 2012
Paula D Jackson Individual Corporate OfficerBoard Member/Corporate Secretary Jun 23, 2008

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 7

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.

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": "1489622400000",
    "number": "1063466068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1999 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402828",
            "telephone_number": "215-228-9300",
            "fax_number": "215-228-9913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA HEALTH ACTION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "D",
        "authorized_official_middle_name": "TINA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPEC.",
        "authorized_official_telephone_number": "215-925-2400"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001374480020",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GPHA Hunting Park Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.