NPIMap

Community Health Clinic, Inc.

Organization Active NPI Clinic/Center · New Kensington, PA

NPI 1699701136 · NPPES record last updated Jun 2, 2016

Key facts

NPI
1699701136
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
License
MD440474 (PA)
Legal business name
COMMUNITY HEALTH CLINIC, INC.
Practice address
943 Fourth Avenue
New Kensington, PA 15068-6409
Phone
(724) 335-3334
Fax
(724) 335-2283
NPI assigned
Jun 25, 2006
Organization subpart
No

Authorized official

Name
Mrs. Raji Jayakrishnan
Title
Executive Director
Phone
(724) 335-3334

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 1

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

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Corporate family (same tax ID) 4

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

Practitioners 11

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0175691Community Health Clinic Inc
943 Fourth Avenue, New Kensington, PA 15068		Certificate of waiverOct 13, 2026
39D2092003Community Health Clinic, Inc
100 Grant Ave, Vandergrift, PA 15690		Certificate of waiverFeb 23, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in PA

Federally qualified health center certification: CCN 391976

Legal name
COMMUNITY HEALTH CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 28, 2007
Last certification
Aug 28, 2007
Ownership / control type
Non-profit – church related
Organization structure
Corporation · Non-profit
Incorporated
Sep 21, 1971 in PA
Enrollment address
943 4TH Ave
New Kensington, PA 15068-6409

Federally qualified health center certification: CCN D31052

Legal name
COMMUNITY HEALTH CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 14, 2025
Last certification
Oct 14, 2025
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Enrollment address
100 Grant Ave
Vandergrift, PA 15690-1208

All disclosed owners & managing parties 12

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

NameRoleSinceShare
William Hall
Individual 		Corporate Director
Ceo		 Aug 2, 2007
Corporate Director
Treasurer		 Aug 2, 2007
Brenda Bowman
Individual 		W-2 Managing Employee
Cfo		 Apr 26, 2010
W-2 Managing Employee Apr 26, 2010
Operational/Managerial Control
Cfo		 Apr 26, 2010
Juanita Nealer
Individual 		Corporate Director
Director		 Mar 1, 2020
Raji Jayakrishnan
Individual 		Corporate Director
Executive Director		 Mar 1, 2020
Operational/Managerial Control
Executive Director		 Mar 1, 2020
Mary Ann Greenlee
Individual 		Corporate Officer
Director		 Mar 1, 2020
Charles Kemp
Individual 		Corporate Director Mar 1, 2020
Sarah Sanders
Individual 		Corporate Director
Director		 Mar 1, 2020
Thomas King
Individual 		Corporate Officer
Board Member / President		 Mar 1, 2020
Hollin West
Individual 		Corporate Director
Director		 Mar 1, 2020
Rick O'Domes
Individual 		Corporate Director
Director		 Mar 1, 2020
Lilian Armstead
Individual 		Corporate Director
Director		 Mar 1, 2020
Barbara Corsi
Individual 		Corporate Officer
Director		 Mar 1, 2020

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Community Health Clinic, Inc.
Greensburg, PA · CCN D31038		 Federally qualified health center Operational/Managerial Control Mar 1, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050411000340 PA Part B Supplier - Clinic/Group Practice 5294772463 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Greensburg, PA; New Kensington, PA; Vandergrift, PA
O20070731000447 PA Part a Provider - Federally Qualified Health Center (FQHC) 5294772463 Practice locations: New Kensington, PA
O20251204002703 PA Part a Provider - Federally Qualified Health Center (FQHC) 5294772463 Practice locations: Vandergrift, PA

National Provider Directory

Tax ID family
Community Health Clinic Inc (5 organizations share this tax ID)

Locations

715 5th Ave
New Kensington, PA 15068

251 7th St
Ste F
New Kensington, PA 15068
Phone (724) 335-3334

100 Grant Ave
Vandergrift, PA 15690
Phone (724) 335-3334

179 Columbia Ave
Vandergrift, PA 15690
Phone (724) 335-3334

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193200000X MULTI-SPECIALTY GROUP		 1223G0001X DS019493L PA
Clinic/Center 261Q00000X MD440474 PA Yes
Clinic/Center 261Q00000X MD035908L PA

Addresses

Primary practice location

943 Fourth Avenue
New Kensington, PA 15068-6409

Mailing address

943 Fourth Avenue
New Kensington, PA 15068-6409
Phone (724) 335-3334

Other identifiers

IdentifierTypeStateIssuer
1546540OtherPAGATEWAY HEALTH PLAN
3976949OtherPAAETNAUS HEALTHCARE GROUP#
001696755OtherPABC/BS GROUP NUMBER
1012676430003MedicaidPA

Other providers in New Kensington, PA

All providers in New Kensington, PA · Clinic/Center in Pennsylvania

Sources for this page

Verify at the official NPI Registry.