Rural Health Corporation of Northeastern Pennsylvania
Organization Active NPI Federally Qualified Health Center (FQHC) · Wilkes Barre, PA
NPI 1265801112 · NPPES record last updated Jan 25, 2024
Key facts
- NPI
- 1265801112
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
- Practice address
- 90 E Union St
Wilkes Barre, PA 18701-3210 - Phone
- (570) 825-0881
- Fax
- (570) 824-8924
- NPI assigned
- Sep 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Matthew J Iskra
- Title
- Cfo
- Phone
- (570) 825-8741
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 4
Practitioners 34
-
Lynn Eckrote, PA-C
-
Gregg J. Novak, D.O.
-
Mary Elizabeth Sokach, D.O.
-
Jurgen Straub, MD
-
Michelle Balas, MD
-
Hannah Elizabeth White, PA-C
-
Billie Jeanne Burry, PHD, CRNP, FNP-BC
-
Katelyn Buyarski, PA-C
-
Sarah Jayne Daywood, DNP, CRNP
-
Kimberly Ann Grzybowski, NP-C
-
Dixon Kitonyo, CRNP
-
Gunnar F. Kosek, D.O.
-
Jessica Neare, DNP, FNP-C
-
Katie Lynn Pernot-Moyer, CRNP
-
Caden T Rozitski, PAC
-
Samuel Edwin Schrack, D.O.
-
Chaya Shuchat, CPNP
-
Hannah Lee Sirak, CRNP
-
Danielle Louise Spadafora, FNP-BC
-
George D Yurko, D.O.
-
Joseph Mark Banyas, D.M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Federally qualified health center certification: CCN 391058
- Legal name
- RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 17, 2015
- Last certification
- Nov 17, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 9, 1970 in PA
- Enrollment address
- 90 E Union St
Ste 2
Wilkes Barre, PA 18701-3201
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Andrew Kalie |
Corporate Director |
Aug 26, 2008 | |
| Lori Gaffney |
Corporate Director |
Sep 28, 1993 | |
| Lisa Bealla |
Corporate Director |
May 13, 2004 | |
| Barbara Bellucci |
Corporate Director |
May 11, 1986 | |
| Charles Leo |
Corporate Officer |
Mar 19, 2024 | |
| W-2 Managing Employee |
Mar 19, 2024 | ||
| Operational/Managerial Control |
Mar 19, 2024 | ||
| Other |
Mar 19, 2024 | ||
| Robert Gaffney |
Corporate Director |
May 9, 2008 | |
| Marian Holehan |
Corporate Director |
Jul 1, 2018 | |
| Richard Love |
Corporate Director |
May 5, 2006 | |
| Dona Maladay |
Corporate Director |
Jul 1, 2018 | |
| Ryan Love |
Corporate Director |
Jul 1, 2018 | |
| Anne E O'Donnell |
Corporate Director |
Jun 24, 2014 | |
| James Palvshock |
Corporate Director |
May 8, 2009 | |
| Emily Havrilla |
Corporate Director |
May 10, 2001 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Valley Medical |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jun 19, 1970 |
| Hazleton Pediatrics |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jun 19, 1970 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050201000488 | PA | Part B Supplier - Clinic/Group Practice | 1052362662 |
Receives reassigned benefits from 34 practitioners 9 other NPIs on this enrollment Practice locations: Monroe Township, PA; Wilkes Barre, PA; Shickshinny, PA; Nuremberg, PA; Laporte, PA; Hazleton, PA; Freeland, PA; Falls, PA… |
| O20151116000079 | PA | Part a Provider - Federally Qualified Health Center (FQHC) | 1052362662 | Practice locations: Wilkes Barre, PA |
National Provider Directory
- Tax ID family
- Freeland RHC
Locations
1084 Plains Township Blvd
Wilkes Barre, PA 18702
Phone (570) 825-8741
90 E Union St
Ste 2
Wilkes Barre, PA 18701
Phone (570) 704-4145
39 E Jackson St
Wilkes Barre, PA 18701
Phone (570) 704-4145
90 E Union St
Wilkes Barre, PA 18701
Phone (570) 825-0881
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
90 E Union St
Wilkes Barre, PA 18701-3210
Mailing address
276 E End Ctr
Wilkes Barre, PA 18702-6970
Phone (570) 825-8741
Other names
- Rural Health Corporation of Northeastern Pennsylvania
Other providers in Wilkes Barre, PA
- Andrea Elizabeth Ruby
- Marissa Lynn Rudzinski-Walter
- Christian Ruffin
- David Rumsey
- Michael D Rupp
- Rural Health Corporation of Northeastern Pennsylvania
- Ryan Christopher Rusnok
- Susan R. Russell
- Stephanie Ashley Russick
- Cynthia A. Russo
All providers in Wilkes Barre, PA · Federally Qualified Health Center (FQHC) in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.