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Childrens Community Care

Organization Active NPI Pediatrics Physician · Greenville, PA

NPI 1558546366 · NPPES record last updated Sep 13, 2023

Key facts

NPI
1558546366
Entity type
Organization (NPI type 2)
Primary specialty
Pediatrics Physician 208000000X
Legal business name
CHILDRENS COMMUNITY CARE
Practice address
90 Shenango St Ste 12
Greenville, PA 16125-2060
Phone
(724) 589-0290
Fax
(724) 589-0293
NPI assigned
Dec 31, 2007
Organization subpart
No

Authorized official

Name
Lori Martinez
Title
Executive Administrator III
Phone
(724) 933-1100

Corporate family (same tax ID) 24

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

Practitioners 2

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D1078757Childrens Cmty Pediatrics Greenville
90 Shenango Street, Suite #12, Greenville, PA 16125		Certificate of waiverJan 15, 2028

National Provider Directory

Tax ID family
Children'S Community Pediatrics (62 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 208000000X Yes

Addresses

Primary practice location

90 Shenango St Ste 12
Greenville, PA 16125-2060

Mailing address

103 Bradford Rd Ste 200
Wexford, PA 15090-6910
Phone (724) 933-1100

Other names

  • Childrens Community Pediatrics Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 13, 2023.

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1558546366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 BRADFORD RD STE 200",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150906910",
            "telephone_number": "724-933-1100",
            "fax_number": "724-933-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 SHENANGO ST STE 12",
            "city": "GREENVILLE",
            "state": "PA",
            "postal_code": "161252060",
            "telephone_number": "724-589-0290",
            "fax_number": "724-589-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS COMMUNITY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-31",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATOR III",
        "authorized_official_telephone_number": "724-933-1100"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childrens Community Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Childrens Community Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greenville, PA

All providers in Greenville, PA · Pediatrics Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.