NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Dingmans Ferry, PA
National Provider Identifier
1689269201
Registry record updated Mar 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Practice address
1592 Route 739 Ste 2
Dingmans Ferry, PA 18328-3513
Phone
(570) 775-8838
Fax
(570) 775-9840
NPI assigned
Mar 5, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2021

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

Authorized official

Name
Joanie Mercado
Title
Business Manager
Phone
(570) 253-8226

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1592 Route 739 Ste 2
Dingmans Ferry, PA 18328-3513

Mailing address

601 Park St
Honesdale, PA 18431-1445
Phone (570) 253-8226

Other names 1

  • Women's Health Dingman's Ferry Other name

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210608001993 PA Part A Provider - Federally Qualified Health Center (FQHC) 3072598937 Practice locations: Dingmans Ferry, PA

Federally qualified health center certification: CCN 731849

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2021
Last certification
Jun 4, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1983 in PA
Enrollment address
1592 Route 739
Ste 2
Dingmans Ferry, PA 18328-3513

All disclosed owners & managing parties 9

Medicare enrollment files

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

NameRoleSinceShare
Carrie Demers Individual Corporate Director May 1, 2018
Michelle Louise Wonders Individual Corporate Director May 1, 2018
Patricia Dunsinger Individual Corporate Director Feb 1, 2019
Gregory Capitolo Individual Corporate Director Feb 1, 2019
William Kerl Individual Corporate Director May 1, 2012
Steve Tourje Individual Corporate Director May 1, 2018
Frederick Jackson Individual Corporate Director Sep 1, 2007
W-2 Managing Employee Sep 1, 2007
Robert Fortuner Individual Corporate Director Feb 1, 2015
W-2 Managing Employee Feb 1, 2015
David Hoff Individual Corporate Director Sep 1, 2007

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1689269201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-253-8226",
            "fax_number": "570-253-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1592 ROUTE 739 STE 2",
            "city": "DINGMANS FERRY",
            "state": "PA",
            "postal_code": "183283513",
            "telephone_number": "570-775-8838",
            "fax_number": "570-775-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "JOANIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "570-253-8226"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Women's Health Dingman's Ferry",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dingmans Ferry, PA

Sources for this page

Verify at the official NPI Registry.