NPIMap

Organization Active NPI

Centerville Clinics, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charleroi, PA
National Provider Identifier
1073734281
Registry record updated Apr 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTERVILLE CLINICS, INC.
Practice address
200 Chamber PLZ
Charleroi, PA 15022-1605
Phone
(724) 483-5482
Fax
(724) 483-5856
NPI assigned
May 2, 2007
Last updated
Apr 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2012

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

Authorized official

Name
Mrs. Patty Martos
Title
Director Personnel Finance
Phone
(724) 632-6801

Specialties & licenses 1

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

Addresses

Primary practice location

200 Chamber PLZ
Charleroi, PA 15022-1605

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Other identifiers 1

IdentifierTypeStateIssuer
1007288440087MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000762 PA Part A Provider - Federally Qualified Health Center (FQHC) 7214837202 Practice locations: Charleroi, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073734281. Details of each certification follow.

Federally qualified health center certification: CCN 391933

Legal name
CENTERVILLE CLINICS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 10, 2004
Last certification
Feb 10, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 2, 1953 in PA
Enrollment address
200 Chamber PLZ
Charleroi, PA 15022-1605

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Centerville Clinics Inc66 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Daniel L Holt Individual W-2 Managing EmployeeMedical Director Jan 1, 2011
Donna Salvino Individual Corporate DirectorSecretary/Treasurer Aug 25, 2014
Edward J Marotta Individual Corporate DirectorBoard Member Nov 23, 2004
Barry R Niccolai Individual Corporate DirectorExecutive Director Apr 1, 2017
W-2 Managing EmployeeManaging Employee Apr 1, 2017
Patricia a Gavazzi Individual Corporate DirectorBoard Member Jun 27, 2017
Darra Tyler-Owens Individual Corporate DirectorBoard Member Sep 29, 2018
Andrew Corfont Individual Corporate DirectorBoard Member Mar 25, 2013
Joseph M Yablonski Individual Corporate OfficerPresident of Board Nov 23, 2004
Patricia Martos Individual W-2 Managing EmployeeDirector of Finance/Personnel Mar 1, 1979
James T Yablonski Individual Corporate DirectorVice President Jan 23, 1995
Marianne E Gideon Individual Corporate DirectorBoard Member Jun 27, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335225600000",
    "number": "1073734281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CHAMBER PLZ",
            "city": "CHARLEROI",
            "state": "PA",
            "postal_code": "150221605",
            "telephone_number": "724-483-5482",
            "fax_number": "724-483-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-02",
        "last_updated": "2012-04-24",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "DIRECTOR PERSONNEL FINANCE",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440087",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleroi, PA

Sources for this page

Verify at the official NPI Registry.