NPIMap

Organization Active NPI

Caring Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilkes Barre, PA
National Provider Identifier
1679038293
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARING COMMUNITY HEALTH CENTER
Practice address
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040
Phone
(570) 829-2621
NPI assigned
Feb 7, 2019
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Matt Rogers
Title
President
Phone
(570) 271-6781

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040

Mailing address

660 Baltimore Dr Ste 125
Wilkes Barre, PA 18702-7962

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190830001893 PA Part B Supplier - Clinic/Group Practice 5698004588 Receives reassigned benefits from 115 practitioners
2 other NPIs on this enrollment
Practice locations: Wilkes Barre, PA; Scranton, PA; Hazle Township, PA
O20210219000088 PA Part A Provider - Federally Qualified Health Center (FQHC) 5698004588 Practice locations: Wilkes Barre, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679038293. Details of each certification follow.

Federally qualified health center certification: CCN 391192

Legal name
CARING COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 16, 2021
Last certification
Feb 16, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Oct 1, 2019 in PA
Enrollment address
175 S Wilkes Barre Blvd
Wilkes Barre, PA 18702-5040

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 2

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

National Provider Directory

National Provider Directory

Locations

660 Baltimore Dr
Ste 125
Wilkes Barre, PA 18702

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Kathryn Hall Individual Corporate Officer Oct 1, 2019
Operational/Managerial Control Oct 1, 2019
David Bolton Individual Corporate Director Oct 1, 2019
Gabrielle M D Amico Individual Corporate Director Oct 1, 2019
Brenda H Hage Individual Corporate Director Oct 1, 2019
Daniel J Gaydon Individual Corporate Director Oct 1, 2019
Michael J Pendal Individual W-2 Managing Employee Oct 1, 2019

Practitioners & affiliated clinicians

Practitioners 136

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 136

NPI Registry JSON

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

{
    "created_epoch": "1549497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1679038293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 BALTIMORE DR STE 125",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187027962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 S WILKES BARRE BLVD",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187025040",
            "telephone_number": "570-829-2621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARING COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-07",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-271-6781"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "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": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.