NPIMap

Organization Active NPI

Primary Care Health Services, Inc.

Doing business as Braddock Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Braddock, PA
National Provider Identifier
1144390683
Registry record updated Oct 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE HEALTH SERVICES, INC.
Doing business as
Braddock Family Health Center
Practice address
404 Braddock Ave
Braddock, PA 15104-1804
Phone
(412) 351-6300
Fax
(412) 351-6500
NPI assigned
Nov 9, 2006
Last updated
Oct 19, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2010

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

Authorized official

Name
Mr. Wilford A. Payne
Title
Executive Director
Phone
(412) 244-4700

Specialties & licenses 1

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

Addresses

Primary practice location

404 Braddock Ave
Braddock, PA 15104-1804

Mailing address

7227 Hamilton Ave
Pittsburgh, PA 15208-1814
Phone (412) 244-4700

Other names 1

  • Braddock Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101124000471 PA Part A Provider - Federally Qualified Health Center (FQHC) 7012825722 Practice locations: Braddock, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144390683. Details of each certification follow.

Federally qualified health center certification: CCN 391915

Legal name
PRIMARY CARE HEALTH SERVICES, INC.
Doing business as
BRADDOCK FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2003
Last certification
Mar 10, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1977 in PA
Enrollment address
404 Braddock Ave
Braddock, PA 15104-1804

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0996174Braddock Family Health Center404 Braddock Avenue, Braddock, PA 15104Provider-performed microscopyFeb 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
West End Health Center16 organizations share this tax ID, including this one
Part of
West End Health Center

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

7225 Hamilton Ave
Pittsburgh, PA 15208
Phone (412) 244-4700

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald Thornhill Individual Corporate Director Sep 27, 2010
Tawnya R. Farris Individual Corporate Director Sep 27, 2010
Carolyn Vera Callahan Individual Corporate Director Sep 27, 2010
John Hollis Individual W-2 Managing EmployeeCoo/ Finance Director Sep 1, 2019
Operational/Managerial ControlCoo/ Finance Director Sep 1, 2019
Judith Ginyard Individual Corporate Director Sep 27, 2010
Lea Blumenfeld Individual Corporate Director Feb 19, 2019
Jerome E Gloster Individual Corporate OfficerCeo Apr 1, 2019
W-2 Managing EmployeeCeo Apr 1, 2019
Richard M. Adams Individual Corporate Director Nov 29, 2010

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 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1144390683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 HAMILTON AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152081814",
            "telephone_number": "412-244-4700",
            "fax_number": "412-244-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 BRADDOCK AVE",
            "city": "BRADDOCK",
            "state": "PA",
            "postal_code": "151041804",
            "telephone_number": "412-351-6300",
            "fax_number": "412-351-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE HEALTH SERVICES, INC.",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "WILFORD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "412-244-4700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Braddock Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Braddock, PA

Sources for this page

Verify at the official NPI Registry.