NPIMap

Organization Active NPI

Primary Care Health Services Inc.

Doing business as Mckeesport Family Health Services

  • Federally Qualified Health Center (FQHC)
  • McKeesport, PA
National Provider Identifier
1629148093
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE HEALTH SERVICES INC.
Doing business as
Mckeesport Family Health Services
Practice address
627 Lysle Blvd
McKeesport, PA 15132-2513
Phone
(412) 664-4112
Fax
(412) 664-0298
NPI assigned
Nov 9, 2006
Last updated
Sep 29, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CARE HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Authorized official

Name
Mr. Wilford A. Payne
Title
Executive Director
Phone
(412) 244-4700

Specialties & licenses 1

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

Addresses

Primary practice location

627 Lysle Blvd
McKeesport, PA 15132-2513

Mailing address

7227 Hamilton Ave
Pittsburgh, PA 15208-1814
Phone (412) 244-4700

Other names 1

  • Mckeesport Family Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101126000002 PA Part A Provider - Federally Qualified Health Center (FQHC) 7012825722 Practice locations: McKeesport, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629148093. Details of each certification follow.

Federally qualified health center certification: CCN 391844

Legal name
PRIMARY CARE HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
627 Lysle Blvd
McKeesport, PA 15132-2524

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Health SVC16 organizations share this tax ID, including this one
Part of
Primary Care Health SVC

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald Thornhill Individual Corporate Director Sep 27, 2010
Tawnya R. Farris Individual Corporate Director Sep 27, 2010
Carolyn Vera Callahan Individual Corporate Director Sep 27, 2010
John Hollis Individual W-2 Managing EmployeeCoo/ Finance Director Apr 1, 2019
Operational/Managerial ControlCoo/ Finance Director Sep 1, 2019
Judith Ginyard Individual Corporate Director Sep 27, 2010
Lea Blumenfeld Individual Corporate Director Sep 27, 2010
Jerome E Gloster Individual Corporate OfficerCeo Apr 1, 2019
W-2 Managing EmployeeCeo Apr 1, 2019
Richard M. Adams Individual Corporate Director Nov 29, 2010

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1629148093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 HAMILTON AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152081814",
            "telephone_number": "412-244-4700",
            "fax_number": "412-244-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 LYSLE BLVD",
            "city": "MCKEESPORT",
            "state": "PA",
            "postal_code": "151322513",
            "telephone_number": "412-664-4112",
            "fax_number": "412-664-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE HEALTH SERVICES INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE HEALTH SERVICES, INC",
        "enumeration_date": "2006-11-09",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "WILFORD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "412-244-4700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mckeesport Family Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McKeesport, PA

Sources for this page

Verify at the official NPI Registry.