NPIMap

Organization Active NPI

Monmouth Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Long Branch, NJ
National Provider Identifier
1073558391
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23104 Issued in NJ
Legal business name
MONMOUTH FAMILY HEALTH CENTER, INC
Practice address
270 Broadway
Long Branch, NJ 07740-7027
Phone
(732) 923-7100
Fax
(732) 923-7104
NPI assigned
Jun 19, 2006
Last updated
Jan 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
Ms. Andrea Duncan
Title
Director, Finance
Phone
(732) 413-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 23104 NJ Primary

Addresses

Primary practice location

270 Broadway
Long Branch, NJ 07740-7027

Mailing address

270 Broadway
Long Branch, NJ 07740-7027
Phone (732) 923-7100

Other identifiers 1

IdentifierTypeStateIssuer
0032361MedicaidNJ

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805001258 NJ Part B Supplier - Clinic/Group Practice 0143291674 Receives reassigned benefits from 36 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Branch, NJ
O20100921000990 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0143291674 Practice locations: Long Branch, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073558391. Details of each certification follow.

Federally qualified health center certification: CCN 311845

Legal name
MONMOUTH FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 10, 2004
Last certification
Nov 10, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2004 in NJ
Enrollment address
270 Broadway
Long Branch, NJ 77407027

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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
31D1023350Monmouth Family Health Center270 Broadway, Long Branch, NJ 07740Certificate of waiverMar 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Monmouth Family Health Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Richard J Degroote Individual Corporate Director Apr 1, 2004
Marta Silverberg Individual Corporate OfficerCeo Apr 1, 2004
Corporate DirectorCeo Apr 1, 2004
W-2 Managing EmployeeCeo Apr 1, 2004
Marjorie Bataty Individual Corporate DirectorBoard Member Apr 28, 2014
Lorraine Poku Individual Corporate OfficerBilling Supervisor Aug 16, 2021
William Arnold Individual Corporate Director Apr 1, 2004
Carl Dejura Individual Corporate DirectorBoard Member Apr 28, 2014
Andrea Duncan Individual Corporate Director Apr 1, 2004
W-2 Managing EmployeeDirector of Patient Accounts Mar 31, 2015
Operational/Managerial ControlDirector of Patient Accounts Apr 24, 2004
Paul McCloud Individual Corporate Director Jan 1, 2022
W-2 Managing EmployeeCfo Jan 1, 2022
Operational/Managerial ControlCfo Jan 1, 2022
Michael Perdoni Individual Corporate DirectorBoard Member Mar 25, 2013
Anna Dowland Individual Corporate Director Apr 1, 2004
Ambar Abelar Individual Corporate Director Apr 1, 2004
Margaret C Fisher Individual Corporate DirectorBoard Member Jan 28, 2013
Andrej Mejer Individual Corporate DirectorBoard Member Mar 25, 2013
Fatima Camacho Individual Corporate DirectorBoard Member Apr 25, 2011
Kathleen Billings Individual Corporate DirectorBoard Member Mar 31, 2014

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 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1073558391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 BROADWAY",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077407027",
            "telephone_number": "732-923-7100",
            "fax_number": "732-923-7104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 BROADWAY",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077407027",
            "telephone_number": "732-923-7100",
            "fax_number": "732-923-7104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONMOUTH FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "DIRECTOR, FINANCE",
        "authorized_official_telephone_number": "732-413-2020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "23104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0032361",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Branch, NJ

Sources for this page

Verify at the official NPI Registry.