NPIMap

Organization Active NPI

Keystone Rural Health Center

Doing business as Keystone Internal Medicine Waynesboro

  • Federally Qualified Health Center (FQHC)
  • Waynesboro, PA
National Provider Identifier
1306665211
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KEYSTONE RURAL HEALTH CENTER
Doing business as
Keystone Internal Medicine Waynesboro
Practice address
1051 E Main Street
Suite 2
Waynesboro, PA 17268-2318
Phone
(717) 709-7922
Fax
(717) 263-2055
NPI assigned
Oct 8, 2024
Last updated
Oct 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KEYSTONE RURAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Authorized official

Name
Joanne Cochran
Title
Ceo
Phone
(717) 709-7906

Specialties & licenses 1

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

Addresses

Primary practice location

1051 E Main Street
Suite 2
Waynesboro, PA 17268-2318

Mailing address

111 Chambers Hill Dr
Suite 200
Chambersburg, PA 17201-7304
Phone (717) 709-7922

Other names 1

  • Keystone Internal Medicine Waynesboro Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040329000065 PA Part B Supplier - Clinic/Group Practice 5496663312 Receives reassigned benefits from 141 practitioners
24 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waynesboro, PA; Chambersburg, PA
O20250110001278 PA Part A Provider - Federally Qualified Health Center (FQHC) 5496663312 Practice locations: Waynesboro, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306665211. Details of each certification follow.

Federally qualified health center certification: CCN D31028

Legal name
KEYSTONE RURAL HEALTH CENTER
Doing business as
KEYSTONE INTERNAL MEDICINE WAYNESBORO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2025
Last certification
Jan 9, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1051 E Main St
Ste 2
Waynesboro, PA 17268-2318

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 19

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

View all 19

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
39D0690119Keystone Internal Med-Waynesboro1051 East Main Street, Waynesboro, PA 17268Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Keystone HLTH Ctr42 organizations share this tax ID, including this one
Part of
Keystone HLTH Ctr

Other organizations with this tax ID 41

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

View all 41

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Mark Smith Individual Corporate Officer May 1, 2024
Muhammad Amer Chaudhry Individual Corporate Officer Jan 1, 2024
Carrie Gray Individual Corporate OfficerChair Oct 1, 2017
Michael Kugler Individual Corporate Officer Jan 1, 2015
Jenna Kaczmarek Individual Corporate OfficerTreasurer Jan 1, 2024
Timothy Henry Individual Corporate Officer Dec 1, 2017
Scott Brown Individual Corporate Officer Jun 2, 2021
Joanne L Cochran Individual Corporate DirectorPresident & Ceo Mar 18, 1987
W-2 Managing EmployeeCeo Sep 24, 1992
William a Morgan Individual Corporate Officer Jun 23, 2004
Karen Pickenheim Johnston Individual Corporate OfficerSecretary Jan 1, 2015
Wanda Dietrich Individual Corporate Officer Jul 4, 2024
Virginia Harriger Individual Corporate Officer Nov 3, 2021
Sila Alegret-Bartel Individual Corporate Officer Jan 1, 2015
Brittany Henderson Individual Corporate Officer Jan 5, 2022

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1728345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1306665211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CHAMBERS HILL DR",
            "address_2": "SUITE 200",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172017304",
            "telephone_number": "717-709-7922",
            "fax_number": "717-263-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 E MAIN STREET",
            "address_2": "SUITE 2",
            "city": "WAYNESBORO",
            "state": "PA",
            "postal_code": "172682318",
            "telephone_number": "717-709-7922",
            "fax_number": "717-263-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE RURAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE RURAL HEALTH CENTER",
        "enumeration_date": "2024-10-08",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "COCHRAN",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "717-709-7906"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Internal Medicine Waynesboro",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waynesboro, PA

Sources for this page

Verify at the official NPI Registry.