NPIMap

Organization Active NPI

Centerville Clinics, Inc

  • Specialist
  • Fredericktown, PA
National Provider Identifier
1720339393
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CENTERVILLE CLINICS, INC
Practice address
179 Crawford Rd
Fredericktown, PA 15333-2011
Phone
(724) 267-4919
NPI assigned
Sep 24, 2012
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Mrs. Patricia Martos
Title
Director Finance/Personnel
Phone
(724) 632-6801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

179 Crawford Rd
Fredericktown, PA 15333-2011

Mailing address

1070 Old National Pike
Fredericktown, PA 15333-2114
Phone (724) 632-6801

Other identifiers 1

IdentifierTypeStateIssuer
328834OtherPAVALUE BEHAVIORAL HEALTH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211027001424 PA Part A Provider - Federally Qualified Health Center (FQHC) 7214837202 Practice locations: Fredericktown, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720339393. Details of each certification follow.

Federally qualified health center certification: CCN 731938

Legal name
CENTERVILLE CLINICS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 8, 2021
Last certification
Oct 8, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Mar 2, 1953 in PA
Enrollment address
179 Crawford Road
Fredericktown, PA 15333-2011

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory

Locations

150 Bearcat Dr
Bentleyville, PA 15314
Phone (724) 239-3606

563 Lincoln Ave
Bentleyville, PA 15314
Phone (724) 239-4431

1152 Wood St
California, PA 15419
Phone (724) 938-2099

93 N Morgantown St
Fairchance, PA 15436
Phone (724) 564-0900

250 E McMurray Rd
McMurray, PA 15317
Phone (724) 941-6260

424 Bower Hill Rd
Venetia, PA 15367
Phone (724) 941-0913

1041 Gabby Ave
Washington, PA 15301
Phone (724) 222-4730

225 Midland Dr
Washington, PA 15301
Phone (724) 222-5064

2500 S Main Street Ext
Washington, PA 15301
Phone (724) 225-7490

84 W Wheeling St
Washington, PA 15301
Phone (724) 222-8530

1367 Hargus Creek Rd
Waynesburg, PA 15370
Phone (724) 499-5183

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Daniel L Holt Individual W-2 Managing EmployeeMedical Director Jan 1, 2011
Donna Salvino Individual Corporate DirectorSecretary/Treasure Aug 25, 2014
Edward J Marotta Individual Corporate DirectorBoard Member Nov 17, 2014
Barry R Niccolai Individual Corporate DirectorExecutive Director Apr 1, 2017
W-2 Managing EmployeeManaging Employee Apr 1, 2017
Patricia a Gavazzi Individual Corporate DirectorBoard Member Jun 27, 2017
Darra Tyler-Owens Individual Corporate DirectorBoard Member Sep 29, 2018
Andrew Corfont Individual Corporate DirectorBoard Member Mar 25, 2013
Joseph M Yablonski Individual Corporate DirectorPresident of Board Nov 23, 2004
Patricia Martos Individual W-2 Managing EmployeeDirector of Finance & Personnel Mar 1, 1979
James T Yablonski Individual Corporate DirectorVice President Jan 23, 1995
Marianne E Gideon Individual Corporate DirectorBoard Member Jun 27, 2016

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 93

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 93

NPI Registry JSON

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

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1720339393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 OLD NATIONAL PIKE",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 CRAWFORD RD",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332011",
            "telephone_number": "724-267-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-24",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "MARTOS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "DIRECTOR FINANCE/PERSONNEL",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE BEHAVIORAL HEALTH",
            "identifier": "328834",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericktown, PA

Sources for this page

Verify at the official NPI Registry.