NPIMap

Organization Active NPI

City of Philadelphia

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1144337189
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITY OF PHILADELPHIA
Practice address
4400 Haverford Ave
Philadelphia, PA 19104-1361
Phone
(215) 685-7628
Fax
(215) 685-6848
NPI assigned
Aug 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Authorized official

Name
Christine Gaddy
Title
Billing Manager
Phone
(215) 685-6843

Specialties & licenses 1

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

Addresses

Primary practice location

4400 Haverford Ave
Philadelphia, PA 19104-1361

Mailing address

1101 Market St FL 10
Revenue Management
Philadelphia, PA 19107-2911
Phone (215) 685-5306

Other identifiers 5

IdentifierTypeStateIssuer
1000076950010MedicaidPA
G0004755MedicaidPA
100084MedicaidPA
33104MedicaidPA
66692OtherPAHIGHMARK BLUE SHIELD

Other names 1

  • Health Care Center 4 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040220000911 PA Part B Supplier - Clinic/Group Practice 6305758723 Receives reassigned benefits from 163 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20110118000935 PA Part A Provider - Federally Qualified Health Center (FQHC) 6305758723 Practice locations: Philadelphia, PA

Federally qualified health center certification: CCN 391874

Legal name
CITY OF PHILADELPHIA
Doing business as
DEPARTMENT OF PUBLIC HEALTH-PHILADELPHIA DISTRICT HEALTH CENTER #4
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 1995
Last certification
Jan 9, 1995
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
4400 Haverford Ave
Philadelphia, PA 19104-1361

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

1900 N 20th St
#5
Philadelphia, PA 19121
Phone (215) 685-2933

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Cheryl Kramer-Sylvester Individual W-2 Managing EmployeeExecutive Director Jan 1, 2021 100%
City of Philadelphia Organization, Philadelphia, PA Operational/Managerial Control Feb 24, 2011
Angela Anhalt Individual W-2 Managing EmployeeCredentialing Specialist Apr 30, 2024
Steven Benson Individual W-2 Managing EmployeeAhs Financial Officer Feb 5, 2015

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Department of Public Health - Philadelphia District HC #2Philadelphia, PA, CCN 391872 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 2015
Department of Public Health - Strawberry Mansion Health CenterPhiladelphia, PA, CCN 391879 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1985
Department of Public Health - Philadelphia District Health Center #10Philadelphia, PA, CCN 391878 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1976
Department of Public Health - Philadelphia District HC #9Philadelphia, PA, CCN 391877 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Department of Public Health - Philadelphia District HC #6Philadelphia, PA, CCN 391876 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1984
Department of Public Health-Philadelphia District HC #5Philadelphia, PA, CCN 391875 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1980
Department of Public Health - Philadelphia District Health Center #3Philadelphia, PA, CCN 391873 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 15, 2015

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 94

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

View all 94

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574640000000",
    "number": "1144337189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MARKET ST FL 10",
            "address_2": "REVENUE MANAGEMENT",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191072911",
            "telephone_number": "215-685-5306",
            "fax_number": "215-685-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 HAVERFORD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191041361",
            "telephone_number": "215-685-7628",
            "fax_number": "215-685-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PHILADELPHIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-11-25",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "215-685-6843"
    },
    "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": "1000076950010",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G0004755",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100084",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33104",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "66692",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Care Center 4",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Care Center 4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.