NPIMap

Organization Active NPI

Public Health Management Corp

Doing business as Philadelphia Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1194822155
Registry record updated Apr 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PUBLIC HEALTH MANAGEMENT CORP
Doing business as
Philadelphia Health Management Corporation
Practice address
1035 W Berks St
Philadelphia, PA 19122-1909
Phone
(215) 765-6690
Fax
(215) 765-6694
NPI assigned
Sep 20, 2006
Last updated
Apr 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2012

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

Authorized official

Name
Mr. Frank Killian
Title
Director - Operations
Phone
(215) 985-2514

Specialties & licenses 1

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

Addresses

Primary practice location

1035 W Berks St
Philadelphia, PA 19122-1909

Mailing address

260 S Broad St FL 18
Philadelphia, PA 19102-5000
Phone (215) 765-6690

Other identifiers 1

IdentifierTypeStateIssuer
1000016640039MedicaidPA

Other names 1

  • Philadelphia Health Management Corporation Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060504000213 PA Part B Supplier - Clinic/Group Practice 1850307406 Receives reassigned benefits from 109 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Flourtown, PA
O20061031000412 PA Part A Provider - Federally Qualified Health Center (FQHC) 1850307406 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194822155. Details of each certification follow.

Federally qualified health center certification: CCN 391965

Legal name
PUBLIC HEALTH MANAGEMENT CORPORATION
Doing business as
PHILADELPHIA HEALTH MANAGEMENT CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2007
Last certification
Jan 9, 2007
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1972 in PA
Enrollment address
1900N 9TH St
Philadelphia, PA 19122-2024

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Patrick Eiding Individual Corporate Director Oct 16, 2006
Denise H Christian Individual Corporate Director Oct 16, 2006
Stephen P Fera Individual Corporate OfficerSecretary Jun 1, 2015
Corporate DirectorBoard Member Jun 1, 2007
Kenneth Braithwaite Individual Corporate Director Jun 1, 2007
Kenneth J Veit Individual Corporate Director Oct 16, 2006
Susan Sherman Individual Corporate Director Oct 16, 2006
Dorothy P Mann Individual Corporate Director Oct 16, 2006
Kathleen Kinslow Individual Corporate OfficerTreasurer Jun 1, 2015
Corporate DirectorBoard Member Jan 1, 2012
James Oram Individual Corporate DirectorBoard Member Jun 1, 2013
Theodore a. Christopher Individual Corporate Director Jun 1, 2009
Frank Killian Individual Contracted Managing Employee Oct 16, 2006
Operational/Managerial ControlDirector of Finance and Reg Jan 1, 2015
Wendell E Pritchett Individual Corporate DirectorBoard Member Jun 1, 2015
Renee Cardwell Hughes Individual Corporate DirectorBoard Member Jan 1, 2007
Sharon M Gallagher Individual Corporate Director Oct 16, 2006
Dinetta Armstrong Individual W-2 Managing Employee Sep 28, 2015
Michael Pearson Individual Corporate Director Jun 1, 2008
George E Downs Individual Corporate Director Oct 16, 2006
J Douglas Macbride Individual Corporate Director Oct 16, 2006
Curtis Schroder Individual Corporate DirectorBoard Member Jan 1, 2012
Andrew Carter Individual Corporate DirectorBoard Member Dec 1, 2014
Richard J Cohen Individual Corporate Director Oct 16, 2006

Owners & managing parties with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1194822155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 S BROAD ST FL 18",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191025000",
            "telephone_number": "215-765-6690",
            "fax_number": "215-765-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 W BERKS ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191221909",
            "telephone_number": "215-765-6690",
            "fax_number": "215-765-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "DIRECTOR - OPERATIONS",
        "authorized_official_telephone_number": "215-985-2514",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "1000016640039",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philadelphia Health Management Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.