Active NPI
Centerville Clinics, Inc.
- School Social Worker
- Washington, PA
National Provider Identifier
1427556646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Social Worker
- Legal business name
- CENTERVILLE CLINICS, INC.
- Practice address
- 231 Park Ave
Trinity High School
Washington, PA 15301 - Phone
- (724) 225-5380
- NPI assigned
- Jan 23, 2018
- Last updated
- Jan 23, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Barry Niccolai
- Title
- Executive Director
- Phone
- (724) 632-6801
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | PA | Primary |
Addresses
Primary practice location
231 Park Ave
Trinity High School
Washington, PA 15301
Mailing address
1070 Old National Pike Road
Centerville Clinics Inc
Fredericktown, PA 15333-2114
Phone (724) 632-6801
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007288440027 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1427556646. Details of each certification follow.
Federally qualified health center certification: CCN 731863
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- CENTERVILLE CLINICS INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jul 2, 2021
- Last certification
- Jul 2, 2021
- Ownership / control type
- For profit – corporation
- Facility address
- 231 Park Avenue
Washington, PA 15301
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516665600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1516665600000",
"number": "1427556646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1070 OLD NATIONAL PIKE ROAD",
"address_2": "CENTERVILLE CLINICS INC",
"city": "FREDERICKTOWN",
"state": "PA",
"postal_code": "153332114",
"telephone_number": "724-632-6801",
"fax_number": "724-632-6312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 PARK AVE",
"address_2": "TRINITY HIGH SCHOOL",
"city": "WASHINGTON",
"state": "PA",
"postal_code": "15301",
"telephone_number": "724-225-5380"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CENTERVILLE CLINICS, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2018-01-23",
"last_updated": "2018-01-23",
"status": "A",
"authorized_official_last_name": "NICCOLAI",
"authorized_official_first_name": "BARRY",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "724-632-6801",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007288440027",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.