NPIMap

Centerville Clinics, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Waynesburg, PA

NPI 1497946776 · NPPES record last updated Oct 25, 2010

Key facts

NPI
1497946776
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CENTERVILLE CLINICS, INC.
Practice address
190 Bonar Ave
Waynesburg, PA 15370-1604
Phone
(724) 627-8156
NPI assigned
Aug 5, 2007
Organization subpart
No

Authorized official

Name
Mrs. Patty Martos
Title
Director Personnel/Finance
Phone
(724) 632-6801

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 23

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

Corporate family (same tax ID) 24

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

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 44

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PA

Federally qualified health center certification: CCN 391829

Legal name
CENTERVILLE CLINICS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 1992
Last certification
Aug 1, 1992
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Mar 2, 1953 in PA
Enrollment address
190 Bonar Ave
Waynesburg, PA 15370-1604

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Daniel L Holt
Individual 		Corporate Director
Medical Director		 Jan 1, 2011
Donna Salvino
Individual 		Corporate Director
Secretary/Treasurer		 Aug 25, 2014
Edward J Marotta
Individual 		Corporate Director
Board Member		 Nov 17, 2014
Barry R Niccolai
Individual 		Corporate Director
Executive Director		 Apr 1, 2017
W-2 Managing Employee
Managing Employee		 Apr 1, 2017
Patricia a Gavazzi
Individual 		Corporate Director
Board Member		 Jun 27, 2017
Darra Tyler-Owens
Individual 		Corporate Director
Board Member		 Sep 29, 2018
Andrew Corfont
Individual 		Corporate Director
Board Member		 Mar 25, 2013
Joseph M Yablonski
Individual 		Corporate Officer
President of Board		 Nov 23, 2004
Patricia Martos
Individual 		W-2 Managing Employee
Director of Finance/Personne		 Mar 1, 1979
James T Yablonski
Individual 		Corporate Director
Vice President		 Jan 23, 1995
Marianne E Gideon
Individual 		Corporate Director
Board Member		 Jun 27, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20101008000277 PA Part a Provider - Federally Qualified Health Center (FQHC) 7214837202 Practice locations: Waynesburg, PA

National Provider Directory

Tax ID family
Centerville Clinics Inc (66 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

190 Bonar Ave
Waynesburg, PA 15370-1604

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Other identifiers

IdentifierTypeStateIssuer
1007288440088MedicaidPA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 25, 2010.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1497946776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "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": "190 BONAR AVE",
            "city": "WAYNESBURG",
            "state": "PA",
            "postal_code": "153701604",
            "telephone_number": "724-627-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "DIRECTOR PERSONNEL/FINANCE",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440088",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesburg, PA

All providers in Waynesburg, PA · Federally Qualified Health Center (FQHC) in Pennsylvania

Sources for this page

Verify at the official NPI Registry.