Fair Hill Community Physicians

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FAIR HILL COMMUNITY PHYSICIANS

Practice address

133 W Hunting Park Ave
Philadelphia, PA 19140-2717

Phone

(215) 324-0600

Fax

(215) 324-2795

NPI assigned

Apr 27, 2023

Last updated

Jun 25, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kera Green

Title

Credentialing Manager

Phone

(267) 264-4669

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA5 enrollments

Enrollment records 5

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1457049439. Details of each certification follow.

• CCN D31058 Federally qualified health center · Active · Details
• CCN D31059 Federally qualified health center · Active · Details
• CCN D31066 Federally qualified health center · Active · Details
• CCN D31064 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN D31058

Legal name

FAIR HILL COMMUNITY PHYSICIANS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 23, 2026

Last certification

Jan 23, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

100 E Lehigh Ave
Philadelphia, PA 19125-1012

Federally qualified health center certification: CCN D31059

Legal name

FAIR HILL COMMUNITY PHYSICIANS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 10, 2026

Last certification

Feb 10, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

133 W Hunting Park Ave
Philadelphia, PA 19140-2717

Federally qualified health center certification: CCN D31066

Legal name

FAIR HILL COMMUNITY PHYSICIANS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 27, 2026

Last certification

May 27, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

1300 W Lehigh Ave
Ste 110
Philadelphia, PA 19132-2760

Federally qualified health center certification: CCN D31064

Legal name

FAIR HILL COMMUNITY PHYSICIANS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 25, 2026

Last certification

Feb 25, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

4350 Germantown Ave
Philadelphia, PA 19140-1749

Locations

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 1

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

• Marc P Hurowitz, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1669458212

  5% Or Greater Indirect Ownership Interest

  CMS ownership

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Fair Hill Community Physicians

  dba Fair Hill Peds Physicians

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1437976149
  NPPES parent name
• Fair Hill Community Physicians

  dba Fair Hill Pharmacy at Liberty Square

  • Clinic Pharmacy
  • Philadelphia, PA
  • NPI 1700728680
  NPPES parent name

Practitioners 23

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.

• Elizabeth Carazo, M.D.

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1629293220
  Medicare reassignment Care Compare group NPD
• Sophia Desrosiers

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1104403062
  Medicare reassignment Care Compare group NPD
• Joshua George, DO

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1003494212
  Medicare reassignment Care Compare group NPD
• David Gonzalez, DO

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1164059697
  Medicare reassignment Care Compare group NPD
• Rene Phillips Kessler

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1356909329
  Medicare reassignment Care Compare group NPD
• Anthony Luistro, MD

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1396922076
  Medicare reassignment Care Compare group NPD
• Nimidia Oviedo, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1770592438
  Medicare reassignment Care Compare group NPD
• Gabriel Sanchez-Aldana Jr., M.D.

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1013025865
  Medicare reassignment Care Compare group NPD
• Alanna Marie Ticali

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1326625161
  Medicare reassignment Care Compare group NPD
• Delana Wardlaw, MD

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1851489405
  Medicare reassignment Care Compare group NPD
• Jennifer Marie Millado, PA-C

  • Medical Physician Assistant
  • Phila, PA
  • NPI 1558649137
  Medicare reassignment Care Compare group
• Gwendolyn Yvette Davis, LCSW, PHD

  • Clinical Social Worker
  • Philadelphia, PA
  • NPI 1225989189
  Medicare reassignment NPD

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

{
    "created_epoch": "1682553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782345600000",
    "number": "1457049439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LEHIGH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251012",
            "telephone_number": "267-264-4669",
            "fax_number": "215-707-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191402717",
            "telephone_number": "215-324-0600",
            "fax_number": "215-324-2795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2301 E Allegheny Ave Ste 150",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191344427",
            "country_code": "US",
            "telephone_number": "215-926-3535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Lehigh Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191251012",
            "country_code": "US",
            "telephone_number": "215-324-0600",
            "fax_number": "215-324-2795",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 W Lehigh Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191322760",
            "country_code": "US",
            "telephone_number": "215-324-0600",
            "fax_number": "215-324-2795",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4350 Germantown Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191401749",
            "country_code": "US",
            "telephone_number": "215-324-0600",
            "fax_number": "215-324-2795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAIR HILL COMMUNITY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-27",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KERA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "267-264-4669"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond Fahrenbach, DDS
• Faina M. Badineva DDS (Esthetique Dental Group PC)
• Nina Fainberg, M.D.
• Anna Faini, PMHNP-BC
• Fair Hill Community Physicians (Fair Hill Peds Physicians)
• Fair Hill Community Physicians (Fair Hill Pharmacy at Liberty Square)
• Constance S Fair, PA
• Grace Fairbrother
• Brandon Fairless, M.D.
• Alexander Fairman

• Federally Qualified Health Center (FQHC) in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Federally Qualified Health Center (FQHC) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; 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.

Verify at the official NPI Registry.