NPIMap

Organization Active NPI

Atlanticare Health Services, Inc.

  • Clinic/Center
  • Atlantic City, NJ
National Provider Identifier
1215987771
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
23265 Issued in NJ
Legal business name
ATLANTICARE HEALTH SERVICES, INC.
Practice address
2009 Bacharach Blvd
Atlantic City, NJ 08401
Phone
(609) 344-5714
Fax
(609) 345-0775
NPI assigned
May 12, 2006
Last updated
May 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Authorized official

Name
Ms. Sandy Festa
Title
Executive Director FQHC
Phone
(609) 572-6051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 23265 NJ Primary

Addresses

Primary practice location

2009 Bacharach Blvd
Atlantic City, NJ 08401

Mailing address

65 W Jimmie Leeds Rd
Attn Finance J Hoke
Pomona, NJ 08205
Phone (609) 569-7303

Other identifiers 3

IdentifierTypeStateIssuer
0028592MedicaidNJ
31D103000OtherNJCMS-CLIA
60019117OtherNJHORIZON HEALTH HMO

Other names 1

  • AtlantiCare Health Services - Mission Healthcare Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040719001204 NJ Part B Supplier - Clinic/Group Practice 7911810916 Receives reassigned benefits from 105 practitioners
9 other NPIs on this enrollment
Practice locations: Pleasantville, NJ; Galloway, NJ; Egg Harbor Township, NJ; Atlantic City, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215987771. Details of each certification follow.

  • CCN 311869 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 311869

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ATLANTICARE HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2006
Last certification
Dec 15, 2006
Ownership / control type
Non-profit – church related
Facility address
2009 Bacharach Blvd
Atlantic City, NJ 08401

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

65 W Jimmie Leeds Rd
#J
Galloway, NJ 08205

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Select Specialty Hospital -Atlantic CityAtlantic City, NJ, CCN 312023 Hospital 5% Or Greater Direct Ownership Interest (20%)
Limited Partnership Interest (20%)		 Apr 2, 2011
Aug 1, 2009
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311008 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Atlanticare Health Services, Inc.Pleasantville, NJ, CCN 311014 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2024
Atlanticare Health Services, Inc.Atlantic City, NJ, CCN 311015 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2022
Atlanticare Health Services, Inc.Egg Harbor Township, NJ, CCN 311017 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023

Owned or controlled facilities with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 106

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 106

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1215987771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 W JIMMIE LEEDS RD",
            "address_2": "ATTN FINANCE J HOKE",
            "city": "POMONA",
            "state": "NJ",
            "postal_code": "08205",
            "telephone_number": "609-569-7303",
            "fax_number": "609-272-6251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 BACHARACH BLVD",
            "city": "ATLANTIC CITY",
            "state": "NJ",
            "postal_code": "08401",
            "telephone_number": "609-344-5714",
            "fax_number": "609-345-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTICARE HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "FESTA",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR FQHC",
        "authorized_official_telephone_number": "609-572-6051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "23265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0028592",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS-CLIA",
            "identifier": "31D103000",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON HEALTH HMO",
            "identifier": "60019117",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AtlantiCare Health Services - Mission Healthcare",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "AtlantiCare Health Services - Mission Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atlantic City, NJ

Sources for this page

Verify at the official NPI Registry.