Community Health Care Rural Health Clinic, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

COMMUNITY HEALTH CARE RURAL HEALTH CLINIC, LLC

Practice address

550 W Walnut St
Shamokin, PA 17872-5226

Phone

(570) 644-2222

Fax

(570) 648-4705

NPI assigned

Feb 10, 2016

Last updated

Feb 10, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Nadine Markovich-Sten, PA-CNPI 1528081791

Title

Member / Administrative Director

Phone

(570) 644-2222

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104284751. Details of each certification follow.

• CCN 393855 Rural health clinic · Active · Details

Rural health clinic certification: CCN 393855

Legal name

COMMUNITY HEALTH CARE RURAL HEALTH CLINIC LLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Apr 21, 1995

Last certification

Mar 4, 2022

Ownership / control type

1B

Most recent change of ownership

May 1, 2016 (1 total)

Organization structure

LLCProprietary

Incorporated

Apr 11, 2008 in PA

Enrollment address

550 West Walnut Street
Shamokin, PA 17872

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Nadine Markovich-Sten, PA-C

  • Physician Assistant
  • Shamokin, PA
  • NPI 1528081791

  5% Or Greater Direct Ownership Interest, Corporate Director, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 1

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.

• Nadine Markovich-Sten, PA-C

  • Physician Assistant
  • Shamokin, PA
  • NPI 1528081791
  NPD Authorized official

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1104284751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W WALNUT ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725226",
            "telephone_number": "570-644-2222",
            "fax_number": "570-648-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W WALNUT ST",
            "city": "SHAMOKIN",
            "state": "PA",
            "postal_code": "178725226",
            "telephone_number": "570-644-2222",
            "fax_number": "570-648-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE RURAL HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "MARKOVICH-STEN",
        "authorized_official_first_name": "NADINE",
        "authorized_official_title_or_position": "MEMBER / ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "570-644-2222",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lou Buendia, MD
• James R Bull, DMD
• Central Penn Physical Therapy Inc.
• Sean Ciborowski
• Community Health Care RHC
• Bradley Ryan Coneharrison, LMT
• Spingarn Crump, RPH
• Duane R. Donmoyer, M.D.
• Darrell William Dudeck, R.PH.
• Tatiana Dyakonova, CRNP

• Rural Health Clinic/Center in Shamokin, PA
• Providers in Shamokin, PA by specialty
• Rural Health Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.