NPIMap

Organization Active NPI

Keystone Rural Health Consortia, Inc.

  • Federally Qualified Health Center (FQHC)
  • Emporium, PA
National Provider Identifier
1609968114
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KEYSTONE RURAL HEALTH CONSORTIA, INC.
Practice address
90 E 2ND St
Emporium, PA 15834-1302
Phone
(814) 486-1115
Fax
(814) 486-0404
NPI assigned
Sep 29, 2006
Last updated
May 28, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Authorized official

Name
Mrs. Kristie Bennardi
Title
Administrator
Phone
(814) 486-1115

Specialties & licenses 1

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

Addresses

Primary practice location

90 E 2ND St
Emporium, PA 15834-1302

Mailing address

90 E 2ND St
P.O. Box 270
Emporium, PA 15834-1302
Phone (814) 486-1115

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050412000691 PA Part B Supplier - Clinic/Group Practice 8022055078 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
Practice locations: Emporium, PA; Kane, PA; Ridgway, PA
O20101029001048 PA Part A Provider - Federally Qualified Health Center (FQHC) 8022055078 Practice locations: Emporium, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609968114. Details of each certification follow.

Federally qualified health center certification: CCN 391888

Legal name
KEYSTONE RURAL HEALTH CONSORTIA, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 1996
Last certification
Nov 1, 1996
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1976 in PA
Enrollment address
90 E 2ND St
Emporium, PA 15834-1302

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

49 Ridgmont Dr
#1
Ridgway, PA 15853
Phone (814) 245-2119

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Sharon Wykoff Individual W-2 Managing EmployeeBilling Manager Apr 9, 2012
Operational/Managerial ControlBilling Manager Apr 9, 2012
Dennis Neal Individual Corporate DirectorMember-Board of Directors Apr 1, 2015
Danielle Reed Individual W-2 Managing EmployeeFin. Controller, Dir. of Operations Mar 14, 2017
Operational/Managerial ControlFin. Controller, Dir. of Operations Mar 14, 2017
John Sidelinger Individual Corporate DirectorMember - Board of Directors Nov 1, 2011
Linda Slyder Individual Corporate DirectorSecretary-Board of Directors Mar 14, 2017
Alan Benson Individual Corporate DirectorMember-Board of Directors Jun 1, 2017
Tonia Hartzell Individual Corporate DirectorPresident - Board of Directors Jun 1, 2017
James Chorney Individual Corporate DirectorTreasurer-Board of Directors Aug 16, 2023
Kristie Lenze Individual Corporate OfficerCeo Aug 23, 2013 5%
W-2 Managing EmployeeCeo Aug 23, 2013
Operational/Managerial ControlCeo Aug 23, 2013 100%
Derrick Goode Individual Corporate DirectorVice President-Board of Director Jan 5, 2018
Kory Fedder Individual Corporate DirectorMember - Board of Directors Aug 28, 2024
Erica Heindl Individual Corporate DirectorMember - Board of Directors Mar 19, 2025
Angela Cunningham Individual Corporate DirectorMember-Board of Directors Feb 16, 2023

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1609968114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 E 2ND ST",
            "address_2": "P.O. BOX 270",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158341302",
            "telephone_number": "814-486-1115",
            "fax_number": "814-486-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 E 2ND ST",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158341302",
            "telephone_number": "814-486-1115",
            "fax_number": "814-486-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE RURAL HEALTH CONSORTIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "BENNARDI",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "814-486-1115",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Emporium, PA

Sources for this page

Verify at the official NPI Registry.