NPIMap

Organization Active NPI

Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • New Kensington, PA
National Provider Identifier
1699701136
Registry record updated Sep 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
MD440474 Issued in 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
Last updated
Sep 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2026

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X DS019493L PA
Federally Qualified Health Center (FQHC) 261QF0400X MD440474 PA Primary

Addresses

Primary practice location

943 Fourth Avenue
New Kensington, PA 15068-6409

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA3 enrollments

Enrollment records 3

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1699701136. Details of each certification follow.

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
CorporationNon-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
CorporationNon-profit
Enrollment address
100 Grant Ave
Vandergrift, PA 15690-1208

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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
39D0175691Community Health Clinic Inc943 Fourth Avenue, New Kensington, PA 15068Certificate of waiverOct 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Health Clinic Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

218 S Maple Ave
Ste 102
Greensburg, PA 15601
Phone (724) 204-1801

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

715 5th Ave
New Kensington, PA 15068

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

179 Columbia Ave
Vandergrift, PA 15690
Phone (412) 567-5671

Ownership & related parties

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 DirectorCeo Aug 2, 2007
Corporate DirectorTreasurer Aug 2, 2007
Brenda Bowman Individual W-2 Managing EmployeeCfo Apr 26, 2010
W-2 Managing Employee Apr 26, 2010
Operational/Managerial ControlCfo Apr 26, 2010
Juanita Nealer Individual Corporate DirectorDirector Mar 1, 2020
Raji Jayakrishnan Individual Corporate DirectorExecutive Director Mar 1, 2020
Operational/Managerial ControlExecutive Director Mar 1, 2020
Mary Ann Greenlee Individual Corporate OfficerDirector Mar 1, 2020
Charles Kemp Individual Corporate Director Mar 1, 2020
Sarah Sanders Individual Corporate DirectorDirector Mar 1, 2020
Thomas King Individual Corporate OfficerBoard Member / President Mar 1, 2020
Hollin West Individual Corporate DirectorDirector Mar 1, 2020
Rick O'Domes Individual Corporate DirectorDirector Mar 1, 2020
Lilian Armstead Individual Corporate DirectorDirector Mar 1, 2020
Barbara Corsi Individual Corporate OfficerDirector 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

Owned or controlled facilities with NPI records 1

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

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.

Practitioners & affiliated clinicians

Practitioners 11

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": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790121600000",
    "number": "1699701136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 FOURTH AVE",
            "city": "NEW KENSINGTON",
            "state": "PA",
            "postal_code": "150686409",
            "telephone_number": "724-335-3334",
            "fax_number": "724-335-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "943 FOURTH AVENUE",
            "city": "NEW KENSINGTON",
            "state": "PA",
            "postal_code": "150686409",
            "telephone_number": "724-335-3334",
            "fax_number": "724-335-2283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A",
        "authorized_official_last_name": "JAYAKRISHNAN",
        "authorized_official_first_name": "RAJI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-335-3334",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS019493L",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": "MD440474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Kensington, PA

Sources for this page

Verify at the official NPI Registry.