NPIMap

Organization Active NPI

Public Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1467776989
Registry record updated Dec 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PUBLIC HEALTH MANAGEMENT CORPORATION
Practice address
1200 Callowhill St
Suite 101
Philadelphia, PA 19123-3658
Phone
(215) 825-8220
Fax
(215) 825-8254
NPI assigned
Mar 26, 2010
Last updated
Dec 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2020

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

Authorized official

Name
Mr. Frank Killian
Title
Director of Finance and Regulatory
Phone
(215) 985-2514

Specialties & licenses 1

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

Addresses

Primary practice location

1200 Callowhill St
Suite 101
Philadelphia, PA 19123-3658

Mailing address

1500 Market St
LM-500 West Tower
Philadelphia, PA 19102-2100
Phone (215) 985-2500

Other identifiers 1

IdentifierTypeStateIssuer
1000016640054MedicaidPA

Other names 1

  • Care Clinic Health Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060504000213 PA Part B Supplier - Clinic/Group Practice 1850307406 Receives reassigned benefits from 109 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Flourtown, PA
O20090430000597 PA Part A Provider - Federally Qualified Health Center (FQHC) 1850307406 1 other NPI on this enrollment
Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467776989. Details of each certification follow.

Federally qualified health center certification: CCN 391989

Legal name
PUBLIC HEALTH MANAGEMENT CORPORATION
Doing business as
PHILADELPHIA HEALTH MANAGEMENT CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 12, 2009
Last certification
Jun 12, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1972 in PA
Enrollment address
1200 Callowhill St
Ste 101
Philadelphia, PA 19123-3658

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Public Health Managment Corporation40 organizations share this tax ID, including this one

Other organizations with this tax ID 39

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

View all 39

Locations

1900 N 9th St
Ste 104
Philadelphia, PA 19122
Phone (215) 765-6690

216 W Somerset St
Fl 2
Philadelphia, PA 19133
Phone (215) 763-8870

500 Adams Ave
Philadelphia, PA 19120
Phone (215) 279-9666

5675 N Front St
Philadelphia, PA 19120
Phone (215) 224-0440

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Patrick Eiding Individual Corporate DirectorBoard Member Jan 1, 2002 5%
Denise H Christian Individual Corporate DirectorChairperson Jan 1, 1991 5%
Stephen P Fera Individual Corporate DirectorBoard Member Jan 1, 2007 5%
Kenneth Braithwaite Individual Corporate DirectorBoard Member Jan 1, 2007 5%
Kenneth J Veit Individual Corporate DirectorBoard Member Jan 1, 1988 5%
Susan Sherman Individual Corporate DirectorBoard Members Jan 1, 2005 5%
Kathleen Kinslow Individual Corporate Director Jan 1, 2024
James Oram Individual Corporate Director Jan 1, 2024
Theodore a. Christopher Individual Corporate DirectorBoard Member Jan 1, 2009 5%
Marino a Puliti Individual Operational/Managerial ControlCfo Dec 1, 2011 100%
Wendell E Pritchett Individual Corporate DirectorDirector Jan 1, 2024
Renee Cardwell Hughes Individual Corporate DirectorBoard Member Jan 1, 2007 5%
Sharon M Gallagher Individual Corporate DirectorSecretary Jan 1, 2000 5%
Michael Pearson Individual Corporate DirectorVice Chairperson Jan 1, 2008 5%
George E Downs Individual Corporate DirectorBoard Member Jan 1, 2005 5%
Brenda Noel Individual Corporate DirectorDeputy Manager Director Jan 1, 2024
J Douglas Macbride Individual Corporate DirectorBoard Member Jan 1, 1977 5%
Curtis Schroder Individual Corporate DirectorBoard Member Jan 1, 2012 5%
Richard J Cohen Individual Corporate DirectorCeo Jan 1, 1974 100%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
PHMC Health Center on Cedar AvenuePhiladelphia, PA, CCN 731950 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2021

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 123

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 123

NPI Registry JSON

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

{
    "created_epoch": "1269561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1467776989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MARKET ST",
            "address_2": "LM-500 WEST TOWER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022100",
            "telephone_number": "215-985-2500",
            "fax_number": "267-765-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CALLOWHILL ST",
            "address_2": "SUITE 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191233658",
            "telephone_number": "215-825-8220",
            "fax_number": "215-825-8254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-26",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE AND REGULATORY",
        "authorized_official_telephone_number": "215-985-2514",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000016640054",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Care Clinic Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.