NPIMap

Organization Active NPI

Esperanza Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1386922714
Registry record updated Mar 29, 2016
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
4417 N. 6TH St.
Philadelphia, PA 19140-2319
Phone
(215) 302-3600
Fax
(215) 329-2369
NPI assigned
Aug 3, 2011
Organization subpart
Yes
Parent organization
ESPERANZA HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Mrs. Glenna J Deem
Title
Credentialing Manager
Phone
(215) 302-3600

Specialties & licenses 1

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

Addresses

Primary practice location

4417 N. 6TH St.
Philadelphia, PA 19140-2319

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1007734560009MedicaidPA
153891OtherMEDICARE PART B PTAN

Medicare participation

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

Enrollment records 2

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
O20111214000203 PA Part A Provider - Federally Qualified Health Center (FQHC) 6103815071 1 other NPI on this enrollment
Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386922714. Details of each certification follow.

Federally qualified health center certification: CCN 391019

Legal name
ESPERANZA HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2011
Last certification
Dec 14, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in PA
Enrollment address
4417 N 6TH Street
Philadelphia, PA 19140-2319

Other NPIs with the same Medicare PAC ID 1

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

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
Part of
Esperanza Health Ctr Inc

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Susan Post Individual Corporate DirectorCeo - Executive Director Nov 1, 2011
W-2 Managing EmployeeCeo - Executive Director Nov 1, 2011
Esperanza Health Center, Inc. Organization, Philadelphia, PA Non-profit Operational/Managerial Control Dec 1, 2011 100%
Timothy Leaman Individual Corporate OfficerChief Medical Officer Nov 28, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Esperanza Health Center, Inc.Philadelphia, PA, CCN 391958 Federally qualified health center Operational/Managerial Control (100%) Sep 1, 2006

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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": "1312329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1386922714",
    "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": "215-807-8395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4417 N. 6TH ST.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402319",
            "telephone_number": "215-302-3600",
            "fax_number": "215-329-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESPERANZA HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESPERANZA HEALTH CENTER",
        "enumeration_date": "2011-08-03",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "DEEM",
        "authorized_official_first_name": "GLENNA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "215-302-3600",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "1007734560009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "153891",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.