NPIMap

Organization Active NPI

Southern Jersey Family Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Salem, NJ
National Provider Identifier
1104940493
Registry record updated May 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.
Practice address
238 E Broadway
Salem, NJ 08079-1108
Phone
(856) 935-7711
Fax
(856) 935-9123
NPI assigned
Mar 19, 2007
Last updated
May 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2026

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

Authorized official

Name
Esther Williams Carpenter
Title
President/Ceo, Interim
Phone
(609) 567-0434

Specialties & licenses 1

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

Addresses

Primary practice location

238 E Broadway
Salem, NJ 08079-1108

Mailing address

1 Executive Dr Ste 400
Marlton, NJ 08053-4278
Phone (609) 567-0434

Other identifiers 1

IdentifierTypeStateIssuer
0033634MedicaidNJ

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040917000774 NJ Part B Supplier - Clinic/Group Practice 0547170763 Receives reassigned benefits from 140 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, NJ; Pleasantville, NJ; Pemberton, NJ; New Lisbon, NJ; Burlington City, NJ; Hammonton, NJ; Atlantic City, NJ
O20041018000329 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0547170763 Practice locations: Salem, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104940493. Details of each certification follow.

Federally qualified health center certification: CCN 311828

Legal name
SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 1994
Last certification
Jul 18, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1997 in NJ
Enrollment address
238 E Broadway
Salem, NJ 80791108
Related CCNs
311804

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1 N White Horse Pike
Hammonton, NJ 08037
Phone (609) 567-0200

860 S White Horse Pike
Hammonton, NJ 08037
Phone (609) 567-0200

1 Executive Dr
Ste 400
Marlton, NJ 08053

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Miguel Bermudez Individual Corporate DirectorBoard Member May 29, 2008
Nellie Rodriguez Individual Corporate DirectorBoard Member May 29, 2008
Teresa Kelly Individual Corporate DirectorBoard Member Sep 9, 2004
Christopher Colon Individual Corporate DirectorBoard Member Feb 13, 2003
Jose a Camacho Individual Corporate DirectorBoard Member May 21, 1998
Norman King Individual Corporate DirectorBoard Member Mar 14, 2002
Reginald Floyd Individual Corporate DirectorBoard Member Sep 10, 1998
Jocelyn Tyson Individual Corporate DirectorBoard Member May 29, 2008
Sylvia K Rigby Individual Corporate DirectorBoard Member Jan 21, 1993
Carol Ramsey Individual Corporate DirectorBoard Member Jul 14, 2005
Ramon Sandoval Individual Corporate DirectorBoard Member Jan 13, 2011
Esther William Carpenter Individual Corporate DirectorPresident/ Ceo, Interim Jan 6, 2026 100%
Operational/Managerial ControlPresident/Ceo, Interim Jan 6, 2026 100%

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 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1104940493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EXECUTIVE DR STE 400",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534278",
            "telephone_number": "609-567-0434",
            "fax_number": "609-704-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 E BROADWAY",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "080791108",
            "telephone_number": "856-935-7711",
            "fax_number": "856-935-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2026-05-05",
        "certification_date": "2026-05-05",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS CARPENTER",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO, INTERIM",
        "authorized_official_telephone_number": "609-567-0434"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0033634",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NJ

Sources for this page

Verify at the official NPI Registry.