NPIMap

Organization Active NPI

Prime Healthcare Services Roxborough LLC

  • Rehabilitation Hospital Unit
  • Philadelphia, PA
National Provider Identifier
1730451899
Registry record updated Feb 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
PRIME HEALTHCARE SERVICES ROXBOROUGH LLC
Practice address
5800 Ridge Ave
Philadelphia, PA 19128-1737
Phone
(215) 483-9900
Fax
(215) 487-4274
NPI assigned
Feb 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2012

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

Authorized official

Name
Michael Sarrao
Title
Vice-President
Phone
(909) 235-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

Primary practice location

5800 Ridge Ave
Philadelphia, PA 19128-1737

Mailing address

3300 E Guasti Rd
3Rd Floor
Ontario, CA 91761-8655
Phone (909) 235-4400

Other names 1

  • Roxborough Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120509000362 PA Part A Provider - Hospital 2567623994 Practice locations: Philadelphia, PA

Hospital certification: CCN 39T304

Legal name
PRIME HEALTHCARE SERVICES ROXBOROUGH LLC
Doing business as
ROXBOROUGH MEMORIAL HOSPITAL
Organization structure
LLCProprietary
Incorporated
Jan 12, 2012 in DE
Enrollment address
5800 Ridge Ave
Philadelphia, PA 19128-1737
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Roxborough Memorial HospitalCCN 39T304
Ownership
For profit
Certified
Dec 19, 2002

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services Roxborough LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation 5% Or Greater Indirect Ownership Interest Feb 22, 2012 100%
Other Jan 12, 2012
Luis Leon Individual Corporate OfficerCorporate Chief Executive Officer Jun 1, 2020
Steven Aleman Individual Corporate OfficerCorporate Chief Financial Officer Jun 1, 2020
Darshan Parekh Individual Corporate OfficerChief Executive Officer Apr 1, 2024
Corporate DirectorDirector Apr 1, 2024
W-2 Managing EmployeeChief Executive Officer Apr 1, 2024
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Sonia C Mehta Individual Corporate OfficerRegional Chief Executive Officer Sep 3, 2020
W-2 Managing EmployeeRegional Chief Executive Officer Sep 3, 2020

Owners & managing parties with NPI records 1

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

Facilities with the same owner 75

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 75

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1730451899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E GUASTI RD",
            "address_2": "3RD FLOOR",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618655",
            "telephone_number": "909-235-4400",
            "fax_number": "909-235-4419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 RIDGE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191281737",
            "telephone_number": "215-483-9900",
            "fax_number": "215-487-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES ROXBOROUGH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "SARRAO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "909-235-4400"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roxborough Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.