NPIMap

Organization Active NPI

Delaware Valley Community Health, Inc.

Doing business as Fairmount Primary Care Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1285699686
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DELAWARE VALLEY COMMUNITY HEALTH, INC.
Doing business as
Fairmount Primary Care Center
Practice address
1412-22 Fairmount Avenue
Philadelphia, PA 19130-2908
Phone
(215) 235-9600
Fax
(215) 232-4093
NPI assigned
Apr 19, 2006
Last updated
Feb 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Authorized official

Name
Ms. Brenda Robles Cooke
Title
President & Ceo
Phone
(215) 684-5344

Specialties & licenses 1

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

Addresses

Primary practice location

1412-22 Fairmount Avenue
Philadelphia, PA 19130-2908

Mailing address

1412-22 Fairmount Avenue
Philadelphia, PA 19130-2908
Phone (215) 235-9600

Other names 1

  • Fairmount Primary Care Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dvchngrts.dvchngrts.p1@direct.dvch.nextgenshare.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030207000004 PA Part A Provider - Federally Qualified Health Center (FQHC) 8426967175 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285699686. Details of each certification follow.

Federally qualified health center certification: CCN 391832

Legal name
DELAWARE VALLEY COMMUNITY HEALTH, INC.
Doing business as
FAIRMOUNT PRIMARY CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1977 in PA
Enrollment address
1412 Fairmount Ave
Philadelphia, PA 19130-2908

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0200609Fairmount Primary Care Center1412-22 Fairmount Avenue, Philadelphia, PA 19130Provider-performed microscopyApr 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Philadelphia Health Ser12 organizations share this tax ID, including this one
Part of
Philadelphia Health Ser

Other organizations with this tax ID 11

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

Locations

1412 Fairmount Ave
#22
Philadelphia, PA 19130

1412 Fairmount Ave
Ste 22
Philadelphia, PA 19130

400 W Allegheny Ave
Philadelphia, PA 19133
Phone (215) 291-9200

400 W Allegheny Ave
Bldg 3
Philadelphia, PA 19133
Phone (215) 546-7501

401 W Allegheny Ave
Bldg 5B
Philadelphia, PA 19133

401 W Allegheny Ave
Ste 55
Philadelphia, PA 19133

841 E Hunting Park Ave
Ste 2
Philadelphia, PA 19124

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Carmen Paris Individual Corporate Director Oct 1, 2013
Alvan Scott McNeal Individual Corporate DirectorPresident and Ceo Jan 1, 2019
W-2 Managing Employee Oct 11, 1993
Marshall Pepper Individual Corporate Director Oct 1, 2013
Carla M Wimbush Individual Corporate Officer Aug 8, 1995
Corporate Director Aug 8, 1995
W-2 Managing Employee Aug 8, 1995
Nilsa Gonzalez Individual Corporate Officer Oct 1, 2013
Corporate Director Oct 1, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Norristown Regional Health CenterNorristown, PA, CCN 391901 Federally qualified health center Operational/Managerial Control Oct 1, 1999
Delaware Valley Community Health, Inc.Philadelphia, PA, CCN 391113 Federally qualified health center Operational/Managerial Control Aug 30, 1977

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 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1285699686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412-22 FAIRMOUNT AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-235-9600",
            "fax_number": "215-684-5360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412-22 FAIRMOUNT AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302908",
            "telephone_number": "215-235-9600",
            "fax_number": "215-232-4093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELAWARE VALLEY COMMUNITY HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "ROBLES COOKE",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "215-684-5344",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dvchngrts.dvchngrts.p1@direct.dvch.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1412-22 Fairmount Avenue",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191302908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Fairmount Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairmount Primary Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.