NPIMap

Organization Active NPI

Monmouth Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Long Branch, NJ
National Provider Identifier
1669791869
Registry record updated Dec 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23168 Issued in NJ
Legal business name
MONMOUTH FAMILY HEALTH CENTER, INC.
Practice address
80 Pavilion Ave
Long Branch, NJ 07740-6413
Phone
(732) 923-7100
NPI assigned
May 27, 2010
Last updated
Dec 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2010

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

Authorized official

Name
Ms. Andrea Duncan
Title
Director, Finance
Phone
(732) 413-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 23168 NJ Primary

Addresses

Primary practice location

80 Pavilion Ave
Long Branch, NJ 07740-6413

Mailing address

270 Broadway
Long Branch, NJ 07740-7027
Phone (732) 923-7100

Other identifiers 1

IdentifierTypeStateIssuer
0237426MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805001258 NJ Part B Supplier - Clinic/Group Practice 0143291674 Receives reassigned benefits from 36 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Branch, NJ
O20100920000739 NJ Part A Provider - Federally Qualified Health Center (FQHC) 0143291674 Practice locations: Long Branch, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669791869. Details of each certification follow.

Federally qualified health center certification: CCN 311846

Legal name
MONMOUTH FAMILY HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 10, 2004
Last certification
Nov 10, 2004
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
80 Pavilion Ave
Long Branch, NJ 77406413

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.

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
31D1103249Monmouth Family Health Center80 Pavilion Avenue, Long Branch, NJ 07740Provider-performed microscopyAug 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Monmouth Family Health Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

270 Broadway
Long Branch, NJ 07740
Phone (732) 923-7100

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Eric Carney Individual Corporate OfficerTreasurer Apr 1, 2024
Lorraine Poku Individual Operational/Managerial ControlBilling Supervisor Jan 1, 2022
Debra Bradley Individual Corporate DirectorVice Chair Apr 1, 2023
Paul McCloud Individual Corporate OfficerCeo Jul 1, 2024
Michael Sirianni Individual Corporate DirectorBoard Member Apr 1, 2023
Richard Garlip Individual Corporate OfficerBoard Member Apr 1, 2024
Kathleen Billings Individual Corporate DirectorChair Apr 1, 2023
Joan Wills Individual Corporate DirectorSecretary Apr 1, 2023
Joyce Quarles Individual Corporate OfficerBoard Member Apr 1, 2024
Ashley Gwathney Individual Corporate OfficerBoard Member Apr 1, 2024

Practitioners & affiliated clinicians

Practitioners 10

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": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1669791869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 BROADWAY",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077407027",
            "telephone_number": "732-923-7100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PAVILION AVE",
            "city": "LONG BRANCH",
            "state": "NJ",
            "postal_code": "077406413",
            "telephone_number": "732-923-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONMOUTH FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "DIRECTOR, FINANCE",
        "authorized_official_telephone_number": "732-413-2020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "23168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0237426",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Branch, NJ

Sources for this page

Verify at the official NPI Registry.