NPIMap

Organization Active NPI

Rural Health Corporation of Northeastern Pennsylvania

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
National Provider Identifier
1265801112
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA
Doing business as
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
Last updated
Jan 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Matthew J Iskra
Title
Cfo
Phone
(570) 825-8741

Specialties & licenses 1

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

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 1

  • Rural Health Corporation of Northeastern Pennsylvania Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265801112. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 9, 1970 in PA
Enrollment address
90 E Union St
Ste 2
Wilkes Barre, PA 18701-3201

Other NPIs with the same Medicare PAC ID 9

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
Tax ID family
Rural Health Corp NE PA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1084 Plains Township Blvd
Wilkes Barre, PA 18702
Phone (570) 825-8741

90 E Union St
Wilkes Barre, PA 18701
Phone (570) 825-0881

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Andrew Kalie Individual Corporate DirectorBoard Member Aug 26, 2008
Lori Gaffney Individual Corporate DirectorBoard Member Sep 28, 1993
Lisa Bealla Individual Corporate DirectorBoard Member May 13, 2004
Barbara Bellucci Individual Corporate DirectorBoard Member May 11, 1986
Charles Leo Individual Corporate OfficerCeo and Director Mar 19, 2024
W-2 Managing EmployeeCeo Mar 19, 2024
Operational/Managerial ControlCeo and Director Mar 19, 2024
OtherCeo Mar 19, 2024
Robert Gaffney Individual Corporate DirectorBoard Member May 9, 2008
Marian Holehan Individual Corporate DirectorBoard Member Jul 1, 2018
Richard Love Individual Corporate DirectorBoard Member May 5, 2006
Dona Maladay Individual Corporate DirectorBoard Member Jul 1, 2018
Ryan Love Individual Corporate DirectorBoard Member Jul 1, 2018
Anne E O'Donnell Individual Corporate DirectorBoard Member Jun 24, 2014
James Palvshock Individual Corporate DirectorBoard Member May 8, 2009
Emily Havrilla Individual Corporate DirectorBoard Member May 10, 2001

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Valley MedicalEdwardsville, PA, CCN 391184 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 19, 1970
Hazleton PediatricsHazleton, PA, CCN 391189 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 19, 1970

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1442880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1265801112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "276 E END CTR",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026970",
            "telephone_number": "570-825-8741",
            "fax_number": "570-825-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 E UNION ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187013210",
            "telephone_number": "570-825-0881",
            "fax_number": "570-824-8924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL HEALTH CORPORATION OF NORTHEASTERN PENNSYLVANIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-22",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "ISKRA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-825-8741"
    },
    "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": "Rural Health Corporation of Northeastern Pennsylvania",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.