NPIMap

Organization Active NPI

Greater Philadelphia Health Action Inc.

Doing business as GPHA Woodland Ave. Dental Services

  • Dental Clinic/Center
  • Philadelphia, PA
National Provider Identifier
1710040878
Registry record updated Mar 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
GREATER PHILADELPHIA HEALTH ACTION INC.
Doing business as
GPHA Woodland Ave. Dental Services
Practice address
5501 Woodland Ave
Philadelphia, PA 19143-5607
Phone
(215) 724-4700
Fax
(215) 724-0919
NPI assigned
Dec 19, 2006
Last updated
Mar 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2017

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

Authorized official

Name
D Tina Smith
Title
Provider Enrollment Spec.
Phone
(215) 925-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

5501 Woodland Ave
Philadelphia, PA 19143-5607

Mailing address

1401 S 31St Street
2ND Floor
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other names 1

  • GPHA Woodland Ave. Dental Services Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110602000389 PA Part B Supplier - Clinic/Group Practice 9537064977 Receives reassigned benefits from 242 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, PA; Philadelphia, PA
O20120601000386 PA Part A Provider - Federally Qualified Health Center (FQHC) 9537064977 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710040878. Details of each certification follow.

Federally qualified health center certification: CCN 391029

Legal name
GREATER PHILADELPHIA HEALTH ACTION INC
Doing business as
GREATER PHILADELPHIA HEALTH ACTION INC-DENTAL & BEHAVIORAL HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 2012
Last certification
Jun 1, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 20, 1970 in PA
Enrollment address
5501 Woodland Avenue
Philadelphia, PA 19143-5607

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

1401 S 4th St
Philadelphia, PA 19147
Phone (215) 339-1070

432 N 6th St
Philadelphia, PA 19123
Phone (215) 627-8000

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Claire a Washington Individual Corporate OfficerBoard Member Mar 1, 2001
Celeste Johns Individual Corporate DirectorReimbursement Director Jun 23, 2008
Janice a Smith Individual Corporate OfficerBoard Member Mar 1, 1979
Valerie E Tuck Individual Corporate OfficerBoard Member Mar 1, 2015
Roger C Collins Individual Corporate OfficerBoard Member, Asst Treasurer Mar 1, 1979
Stephen R Cox Individual Corporate OfficerBoard Member, Second Vice Chair Mar 1, 2000
Royal E Brown Individual Corporate OfficerBoard Member/Chair Person Mar 1, 1988
Brian Clark Individual Corporate OfficerCeo/Executive Director Jan 1, 2018
Corporate DirectorCeo/Executive Director Jan 1, 2018
W-2 Managing EmployeeCeo/Executive Director Jan 1, 2018
Sandra Hawkins-Dorsey Individual Corporate OfficerBoard Member Mar 1, 2004
Minnie Moore-Johnson Individual Corporate OfficerMember May 1, 2020
Flora M Castillo Individual Corporate OfficerBoard Member Mar 1, 2008
Linda W Powell Individual Corporate OfficerBoard Member/First VP Mar 1, 2004
Phyllis H Detwiler Individual Corporate OfficerBoard Member Mar 1, 2012
Paula D Jackson Individual Corporate OfficerBoard Member, Corporate Secretar Mar 1, 1993

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1710040878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST STREET",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191435607",
            "telephone_number": "215-724-4700",
            "fax_number": "215-724-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA HEALTH ACTION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "D",
        "authorized_official_middle_name": "TINA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPEC.",
        "authorized_official_telephone_number": "215-925-2400"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GPHA Woodland Ave. Dental Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.