NPIMap

Organization Active NPI

Southern Jersey Family Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pemberton, NJ
National Provider Identifier
1205951019
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
600 Pemberton Browns Mills Rd
Pemberton, NJ 08068-1537
Phone
(609) 894-1100
Fax
(609) 894-1110
NPI assigned
Mar 20, 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

600 Pemberton Browns Mills Rd
Pemberton, NJ 08068-1537

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0071927MedicaidNJ

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
O20050323001293 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0547170763 Practice locations: New Lisbon, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205951019. Details of each certification follow.

Federally qualified health center certification: CCN 311859

Legal name
SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 17, 2005
Last certification
May 17, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1977 in NJ
Enrollment address
600 Pemberton-Browns Mills Road
New Lisbon, NJ 80680248

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
Tax ID family
Southern Jersey Family Medical Centers4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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
Linda Y Flake Individual Corporate DirectorPresident/Ceo May 4, 1992 100%
Operational/Managerial ControlPresident/Ceo May 4, 1992 100%
Miguel Bermudez Individual Corporate DirectorBoard Member May 3, 2008
Nellie Rodriguez Individual Corporate DirectorBoard Member May 3, 2008
Teresa Kelly Individual Corporate DirectorBoard Member Mar 16, 2007
Christopher Colon Individual Corporate DirectorBoard Member Mar 16, 2007
Jose a Camacho Individual Corporate DirectorBoard Member Mar 16, 2007
Norman King Individual Corporate DirectorBoard Member Mar 16, 2007
Reginald Floyd Individual Corporate DirectorBoard Member Mar 16, 2007
Jocelyn Tyson Individual Corporate DirectorBoard Member May 3, 2008
Sylvia K Rigby Individual Corporate DirectorBoard Member Mar 16, 2007
Connie Troilo Individual Corporate DirectorBoard Member Jan 1, 2018
Carol Ramsey Individual Corporate DirectorBoard Member Mar 16, 2007

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 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777939200000",
    "number": "1205951019",
    "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": "600 PEMBERTON BROWNS MILLS RD",
            "city": "PEMBERTON",
            "state": "NJ",
            "postal_code": "080681537",
            "telephone_number": "609-894-1100",
            "fax_number": "609-894-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN JERSEY FAMILY MEDICAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "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": "0071927",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pemberton, NJ

Sources for this page

Verify at the official NPI Registry.