Community Health Care Rural Health Clinic, LLC

Key facts

NPI: 1104284751
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 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
Organization subpart: No

Authorized official

Name: Ms. Nadine Markovich-Sten, PA-C
Title: Member / Administrative Director
Phone: (570) 644-2222

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

CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE DIRECTOR · OPERATIONAL/MANAGERIAL CONTROL · W-2 MANAGING EMPLOYEE

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Nadine Markovich-Sten, PA-C Physician Assistant · Shamokin, PA · NPI 1528081791

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PA

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: LLC · Proprietary
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.

Name	Role	Since	Share
Nadine Markovich-Sten Individual	5% Or Greater Direct Ownership Interest	Apr 11, 2008	100%
	Corporate Director Member	Apr 11, 2008	100%
	W-2 Managing Employee Clinic Administrator	Jun 1, 2018	100%
	Operational/Managerial Control Clinic Administrator	Jun 1, 2018	100%

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20160310000815	PA	Part a Provider - Rural Health Clinic	0941506398	Practice locations: Shamokin, PA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X			Yes

Addresses

Primary practice location

550 W Walnut St
Shamokin, PA 17872-5226

Mailing address

550 W Walnut St
Shamokin, PA 17872-5226
Phone (570) 644-2222

Other providers in Shamokin, PA

All providers in Shamokin, PA · Rural Health Clinic/Center in Pennsylvania

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.