NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

  • Federally Qualified Health Center (FQHC)
  • Troy, PA
National Provider Identifier
1417536285
Registry record updated May 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Practice address
45 Mud Creek Rd
Troy, PA 16947-9529
Phone
(570) 297-3746
Fax
(570) 297-5127
NPI assigned
Apr 7, 2021
Last updated
May 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2024

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

Authorized official

Name
Ronald M Gilbert
Title
Cfo
Phone
(570) 662-1955

Specialties & licenses 1

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

Addresses

Primary practice location

45 Mud Creek Rd
Troy, PA 16947-9529

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000152 PA Part B Supplier - Clinic/Group Practice 0446245880 Receives reassigned benefits from 67 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mansfield, PA; Westfield, PA; Wellsboro, PA; Troy, PA; Towanda, PA; Blossburg, PA; Elkland, PA; Lawrenceville, PA…
O20210518002154 PA Part A Provider - Federally Qualified Health Center (FQHC) 0446245880 Practice locations: Troy, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417536285. Details of each certification follow.

Federally qualified health center certification: CCN 731831

Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
TROY LAUREL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 3, 2021
Last certification
May 3, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1972 in PA
Enrollment address
45 Mud Creek Rd
Troy, PA 16947-9529

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 14

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

View all 14

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
39D2229912Troy Laurel Health Center45 Mud Creek Road, Troy, PA 16947Certificate of waiverDec 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Penn Family Healt14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

6 Riverside Plz
Blossburg, PA 16912
Phone (570) 638-2174

6A Riverside Plz
Blossburg, PA 16912

103 Forestview Ave
Elkland, PA 16920
Phone (814) 258-5117

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Scott D Myers Individual Corporate DirectorBoard Member Apr 1, 2025
John Dennis Murray Individual Corporate Director Jun 1, 2013 100%
Donna R Wilson Individual Corporate OfficerSecretary Jun 1, 2013 100%
Sean Sember Individual Corporate DirectorBoard Member Sep 22, 2021
James a Nobles Individual Corporate Director Mar 30, 2018
W-2 Managing EmployeeCeo Mar 30, 2018 100%
Operational/Managerial Control Mar 30, 2018 100%
Thomas Thompson Individual Corporate OfficerTreasurer Jan 1, 2022
Jody Thomas Individual Corporate OfficerChairman Jul 1, 2019 100%
Megan Wells-Williams Individual Corporate DirectorBoard Member Jul 7, 2021
Kelly Irwin Individual Corporate DirectorBoard Member Jan 1, 2023
Ronald M Gilbert Individual Corporate DirectorDirector Aug 14, 2015 100%
W-2 Managing EmployeeCfo Aug 14, 2015 100%
Operational/Managerial Control Aug 14, 2015 100%
Kimberly Johns Individual Corporate DirectorBoard Member Jan 1, 2022
Kristopher Kaufman Individual Corporate DirectorBoard Member Jan 1, 2022
Jason Krise Individual Corporate OfficerChairman Jan 1, 2021

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1417536285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 MUD CREEK RD",
            "city": "TROY",
            "state": "PA",
            "postal_code": "169479529",
            "telephone_number": "570-297-3746",
            "fax_number": "570-297-5127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-07",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-662-1955"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, PA

Sources for this page

Verify at the official NPI Registry.