NPIMap

Organization Active NPI

Greater Philadelphia Health Action, Inc.

Doing business as GPHA-Delaware Avenue Health Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1427533280
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER PHILADELPHIA HEALTH ACTION, INC.
Doing business as
GPHA-Delaware Avenue Health Center
Practice address
1080 N Delaware Ave
Philadelphia, PA 19125-4330
Phone
(215) 925-2400
Fax
(215) 925-9162
NPI assigned
Sep 27, 2018
Last updated
Oct 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

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

Authorized official

Name
Celeste Johns, MBA, CPC
Title
Director
Phone
(215) 925-2400

Specialties & licenses 1

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

Addresses

Primary practice location

1080 N Delaware Ave
Philadelphia, PA 19125-4330

Mailing address

1401 S 31St St FL 2
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other names 1

  • GPHA-Delaware Avenue 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
O20110602000389 PA Part B Supplier - Clinic/Group Practice 9537064977 Receives reassigned benefits from 242 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, PA; Philadelphia, PA
O20181228000866 PA Part A Provider - Federally Qualified Health Center (FQHC) 9537064977 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427533280. Details of each certification follow.

Federally qualified health center certification: CCN 391123

Legal name
GREATER PHILADELPHIA HEALTH ACTION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 7, 2018
Last certification
Dec 7, 2018
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 20, 1970 in PA
Enrollment address
1080 N Delaware Ave
Philadelphia, PA 19125-4330

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Greater Philadelphia Health39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

1401 S 31st St
Philadelphia, PA 19146
Phone (215) 755-7700

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
Claire a Washington Individual Corporate OfficerBoard Member Mar 1, 2001
Janice a Smith Individual Corporate OfficerBoard Member Mar 1, 1979
Ashley a Hines Individual Corporate OfficerBoard Member Oct 1, 2006
Valerie E Tuck Individual Corporate OfficerBoard Member Mar 1, 2015
Roger C Collins Individual Corporate OfficerBoard Member Assistant Treasurer Mar 1, 1979
Stephen R Cox Individual Corporate OfficerBoard Member Second Vice Chair P Mar 1, 2008
Royal E Brown Individual Corporate OfficerBoard Member Chair Person Mar 1, 1988
Brian Clark Individual Corporate OfficerCeo Executive Director Jan 1, 2018
Corporate DirectorCeo Executive Director Jan 1, 2018
W-2 Managing EmployeeCeo Executive Director Jan 1, 2018
Sandra Hawkins-Dorsey Individual Corporate OfficerBoard Member Mar 1, 2004
Flora M Castillo Individual Corporate OfficerBoard Member Mar 1, 2008
Linda W Powell Individual Corporate OfficerBoard Member First Vice Presiden Mar 1, 2004
Phyllis H Detwiler Individual Corporate OfficerBoard Member Mar 1, 2012
Ann L Colley Individual Corporate OfficerBoard Member May 8, 2017
Paula D Jackson Individual Corporate OfficerBoard Member Corporate Secretary Mar 1, 1993

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1538006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1427533280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST FL 2",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 N DELAWARE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191254330",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA HEALTH ACTION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-27",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "JOHNS",
        "authorized_official_first_name": "CELESTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "215-925-2400",
        "authorized_official_credential": "MBA, CPC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GPHA-Delaware Avenue Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.