NPIMap

Organization Active NPI

Greater Philadelphia Health Action Inc.

Doing business as GPHA - Carl Moore Health Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1609321041
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER PHILADELPHIA HEALTH ACTION INC.
Doing business as
GPHA - Carl Moore Health Center
Practice address
1401 S. 31St Street
Philadelphia, PA 19146-3506
Phone
(215) 925-2400
Fax
(215) 925-9162
NPI assigned
Aug 15, 2016
Last updated
Mar 15, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Authorized official

Name
D Tina Smith
Title
Provider Enrollment Spec.
Phone
(215) 925-2400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1401 S. 31St Street
Philadelphia, PA 19146-3506

Mailing address

1401 S. 31St Street
2ND Floor
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other names 1

  • GPHA - Carl Moore Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110602000389 PA Part B Supplier - Clinic/Group Practice 9537064977 Receives reassigned benefits from 242 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, PA; Philadelphia, PA
O20160915000427 PA Part A Provider - Federally Qualified Health Center (FQHC) 9537064977 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609321041. Details of each certification follow.

Federally qualified health center certification: CCN 391079

Legal name
GREATER PHILADELPHIA HEALTH ACTION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 22, 2016
Last certification
Aug 22, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 20, 1970 in PA
Enrollment address
1401 S 31St Street
Philadelphia, PA 19146-3506

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 11

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2116811Gpha Carl Moore Health Center1401 South 31St St, Philadelphia, PA 19146Provider-performed microscopyAug 1, 2026

National Provider Directory

National Provider Directory

Locations

1080 N Delaware Ave
Philadelphia, PA 19125
Phone (215) 287-2114

3223 N Broad St
Philadelphia, PA 19140
Phone (215) 707-2900

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Claire a Washington Individual Corporate OfficerBoard Member Mar 1, 2001
Celeste Johns Individual Corporate DirectorReimbursement Director Jun 23, 2008
Janice a Smith Individual Corporate OfficerBoard Member Mar 1, 1979
Ashley a Hines Individual Corporate OfficerBoard Member Oct 1, 2006
Valerie E Tuck Individual Corporate OfficerBoard Member Mar 1, 2015
Roger C Collins Individual Corporate OfficerBoard Member / Assistant Treasur Mar 1, 1979
Stephen R Cox Individual Corporate OfficerBoard Member/ Second Vice Chairp Mar 1, 2000
Royal E Brown Individual Corporate OfficerBoard Member / Chairperson Mar 1, 1988
Brian Clark Individual Corporate OfficerCeo/Executive Director Jan 1, 2018
Corporate DirectorCeo/Executive Director Jan 1, 2018
W-2 Managing EmployeeCeo/Executive Director Jan 1, 2018
Sandra Hawkins-Dorsey Individual Corporate OfficerBoard Member Mar 1, 2004
Flora M Castillo Individual Corporate OfficerBoard Member Mar 1, 2008
Linda W Powell Individual Corporate OfficerBoard Member / First Vice Presid Mar 1, 2004
Phyllis H Detwiler Individual Corporate OfficerBoard Member Mar 1, 2012
Ann L Colley Individual Corporate OfficerBoard Member May 8, 2017
Paula D Jackson Individual Corporate OfficerBoard Member/ Corporate Secretar Mar 1, 1993

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1471219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1609321041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S. 31ST STREET",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S. 31ST STREET",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA HEALTH ACTION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-15",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "D",
        "authorized_official_middle_name": "TINA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPEC.",
        "authorized_official_telephone_number": "215-925-2400"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GPHA - Carl Moore Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.