NPIMap

Organization Active NPI

Esperanza Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1306896394
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESPERANZA HEALTH CENTER, INC.
Practice address
861 E Allegheny Ave
Philadelphia, PA 19134-2401
Phone
(215) 831-1100
Fax
(215) 831-0500
NPI assigned
May 11, 2006
Organization subpart
Yes
Parent organization
ESPERANZA HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Authorized official

Name
Glenna J Deem
Title
Executive Assistant
Phone
(215) 302-3150

Specialties & licenses 1

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

Addresses

Primary practice location

861 E Allegheny Ave
Philadelphia, PA 19134-2401

Mailing address

4417 N. 6TH St.
Philadelphia, PA 19140-2319
Phone (215) 302-3600

Other identifiers 2

IdentifierTypeStateIssuer
1007734560008MedicaidPA
1007734560010MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040507000367 PA Part B Supplier - Clinic/Group Practice 6103815071 Receives reassigned benefits from 53 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20060707000089 PA Part A Provider - Federally Qualified Health Center (FQHC) 6103815071 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20060707000095 PA Part A Provider - Federally Qualified Health Center (FQHC) 6103815071 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

Federally qualified health center certification: CCN 391958

Legal name
ESPERANZA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 25, 2006
Last certification
Jul 25, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 24, 1987 in PA
Enrollment address
2940 N 5TH St
Philadelphia, PA 19133-2801

Federally qualified health center certification: CCN 391959

Legal name
ESPERANZA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 25, 2006
Last certification
Jul 25, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 24, 1987 in PA
Enrollment address
861 E Allegheny Ave
Philadelphia, PA 19134-2401

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Crossroads Rhode Island2 organizations share this tax ID, including this one
Part of
Esperanza Health Center

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Stephanie Stanford Individual Corporate Director Apr 24, 2014
Corporate DirectorBoard Secretary Apr 24, 2014
David Crosscombe Individual Corporate Director Apr 1, 2000
Shana Kline Individual Corporate DirectorDirector/President Dec 15, 2016
Corporate DirectorDirector Dec 15, 2016
Alan Popoli Individual Corporate OfficerBoard Treasurer Aug 26, 2019
Taehoo Lee Individual Corporate Director Jul 25, 2014
Corporate DirectorDirector Jul 25, 2014
Ruth Elliot Individual Corporate OfficerBoard Secretary Mar 4, 2022
Eapen Johnson Individual Corporate DirectorChief Administrative Officer Jul 1, 2024
Susan Post Individual Corporate Director Feb 1, 2005
Corporate OfficerExecutive Director Feb 1, 2005
W-2 Managing Employee Feb 1, 2005
Operational/Managerial ControlExecutive Director Feb 1, 2005
Esperanza Health Center, Inc. Organization, Philadelphia, PA Non-profit Operational/Managerial Control Sep 1, 2006 100%
Juan Perez Individual Operational/Managerial ControlDirector of Operations Nov 18, 2013
W-2 Managing EmployeeOperations Director Nov 18, 2013
Timothy Leaman Individual Operational/Managerial ControlChief Medical Officer Nov 28, 2022
Jacinto Gomez Individual Corporate DirectorDirector Oct 22, 2009
Lara Maria Lahr Individual Corporate DirectorDirector Feb 22, 2018
Erik Davis Individual W-2 Managing EmployeeFinance Director Sep 15, 2011
Bryan R Hollinger Individual W-2 Managing EmployeeMedical Director Oct 1, 1994
Roberto Vargas Individual Corporate DirectorBoard Vice President Apr 26, 2012
Nancy Rivera Individual Corporate DirectorDirector Feb 25, 2016
Glenna J Deem Individual W-2 Managing EmployeeCredentialing Manager Jun 25, 2015

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1306896394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4417 N. 6TH ST.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3600",
            "fax_number": "215-805-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "861 E ALLEGHENY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191342401",
            "telephone_number": "215-831-1100",
            "fax_number": "215-831-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESPERANZA HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESPERANZA HEALTH CENTER, INC.",
        "enumeration_date": "2006-05-11",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "DEEM",
        "authorized_official_first_name": "GLENNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "215-302-3150"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007734560008",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007734560010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.