NPIMap

Organization Active NPI

City of Philadelphia

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1417064353
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITY OF PHILADELPHIA
Practice address
2840 W Dauphin St
Strawberry Mansion Health Ctr
Philadelphia, PA 19132-4627
Phone
(215) 685-2403
Fax
(215) 685-6848
NPI assigned
Aug 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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

Authorized official

Name
Christine Gaddy
Title
Billing Manager
Phone
(215) 685-6843

Specialties & licenses 1

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

Addresses

Primary practice location

2840 W Dauphin St
Strawberry Mansion Health Ctr
Philadelphia, PA 19132-4627

Mailing address

1101 Market St FL 10
Revenue Management
Philadelphia, PA 19107-2911
Phone (215) 685-5306

Other identifiers 5

IdentifierTypeStateIssuer
66692OtherPAHIGHMARK BLUE SHIELD
G0001311MedicaidPA
00900MedicaidPA
1000076950015MedicaidPA
1008117MedicaidPA

Other names 1

  • Strawberry Mansion Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040220000911 PA Part B Supplier - Clinic/Group Practice 6305758723 Receives reassigned benefits from 163 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20110118000324 PA Part A Provider - Federally Qualified Health Center (FQHC) 6305758723 Practice locations: Philadelphia, PA

Federally qualified health center certification: CCN 391879

Legal name
CITY OF PHILADELPHIA
Doing business as
DEPARTMENT OF PUBLIC HEALTH - STRAWBERRY MANSION HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 1995
Last certification
Jan 9, 1995
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
2840W Dauphin St
Philadelphia, PA 19132-4627

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 8

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

National Provider Directory

National Provider Directory
Tax ID family
Health Center 223 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Laval Miller-Wilson Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
Cheryl Kramer-Sylvester Individual Corporate OfficerChief Executive Officer Jan 1, 2021 100%
Mary Smith Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
City of Philadelphia Organization, Philadelphia, PA 5% Or Greater Direct Ownership Interest Apr 1, 1985 100%
Carol Rogers Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
Marilyn Bradshaw Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
Marisa Rogers Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
Steven Benson Individual W-2 Managing EmployeeAhs Financial Officer May 15, 2015
Siomara Lopez Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014
Kusema Warrakah Individual W-2 Managing Employee May 15, 2015
OtherAhs Board Member Sep 17, 2014

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Department of Public Health - Philadelphia District HC #2Philadelphia, PA, CCN 391872 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 2015
Department of Public Health - Philadelphia District Health Center #10Philadelphia, PA, CCN 391878 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1976
Department of Public Health - Philadelphia District HC #9Philadelphia, PA, CCN 391877 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Department of Public Health - Philadelphia District HC #6Philadelphia, PA, CCN 391876 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1984
Department of Public Health-Philadelphia District Health Center #4Philadelphia, PA, CCN 391874 Federally qualified health center Operational/Managerial Control Feb 24, 2011
Department of Public Health-Philadelphia District HC #5Philadelphia, PA, CCN 391875 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1980
Department of Public Health - Philadelphia District Health Center #3Philadelphia, PA, CCN 391873 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 15, 2015

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 96

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

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575331200000",
    "number": "1417064353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MARKET ST FL 10",
            "address_2": "REVENUE MANAGEMENT",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191072911",
            "telephone_number": "215-685-5306",
            "fax_number": "215-685-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2840 W DAUPHIN ST",
            "address_2": "STRAWBERRY MANSION HEALTH CTR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191324627",
            "telephone_number": "215-685-2403",
            "fax_number": "215-685-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PHILADELPHIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-12-03",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "215-685-6843"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "66692",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G0001311",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00900",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000076950015",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008117",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Strawberry Mansion Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Strawberry Mansion Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.