NPIMap

Organization Active NPI

City of Philadelphia

Doing business as Health Care Center 3

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1740397769
Registry record updated Dec 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CITY OF PHILADELPHIA
Doing business as
Health Care Center 3
Practice address
555 S 43Rd St
Health Care Center 3
Philadelphia, PA 19104-4408
Phone
(215) 685-7522
Fax
(215) 685-6848
NPI assigned
Aug 24, 2006
Last updated
Dec 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2019

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

Authorized official

Name
Christine Gaddy
Title
Billing Manager
Phone
(215) 685-6843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X PA Primary

Addresses

Primary practice location

555 S 43Rd St
Health Care Center 3
Philadelphia, PA 19104-4408

Mailing address

1101 Market St FL 10
Revenue Management
Philadelphia, PA 19107-2911
Phone (215) 685-5306

Other identifiers 5

IdentifierTypeStateIssuer
1000076950009MedicaidPA
66692OtherPAHIGHMARK BLUE SHIELD
66692OtherPAHIGH MARK BLUE SHIELD
100083MedicaidPA
G0004744MedicaidPA

Other names 1

  • Health Care Center 3 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040220000911 PA Part B Supplier - Clinic/Group Practice 6305758723 Receives reassigned benefits from 163 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20110118001019 PA Part A Provider - Federally Qualified Health Center (FQHC) 6305758723 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740397769. Details of each certification follow.

Federally qualified health center certification: CCN 391873

Legal name
CITY OF PHILADELPHIA
Doing business as
DEPARTMENT OF PUBLIC HEALTH - PHILADELPHIA DISTRICT HEALTH CENTER #3
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 1995
Last certification
Jan 9, 1995
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
555 S 43Rd St
Philadelphia, PA 19104-4408

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
City of Phila Doh23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

555 S 43rd St
Philadelphia, PA 19104
Phone (215) 685-7500

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
Laval Miller-Wilson Individual Corporate DirectorAhs Board of Directors Sep 17, 2014
Cheryl Kramer-Sylvester Individual Corporate OfficerChief Executive Officer Jan 1, 2021 100%
Mary Smith Individual Corporate DirectorAhs Board of Directors Sep 17, 2014
City of Philadelphia Organization, Philadelphia, PA 5% Or Greater Direct Ownership Interest May 15, 2015 100%
Carol Rogers Individual Corporate DirectorAhs Board of Directors Sep 17, 2014
Marilyn Bradshaw Individual Corporate DirectorAhs Board of Directors Sep 17, 2014
Marisa Rogers Individual Corporate DirectorAhs Board of Directors Sep 17, 2014
Angela Anhalt Individual W-2 Managing EmployeeCredentialing Specialist Apr 30, 2024
Steven Benson Individual W-2 Managing EmployeeAhs Financial Officer May 15, 2015
Siomara Lopez Individual Corporate DirectorAhs Board of Directors Jun 12, 2015
Kusema Warrakah Individual Corporate DirectorAhs Board of Directors Sep 17, 2014

Owners & managing parties with NPI records 10

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

  • City of Philadelphia

    dba Health Care Center 6

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1023125085

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 4

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1144337189

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba City of Philadelphia - Fire Department

    • Land Ambulance
    • Philadelphia, PA
    • NPI 1255468435

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Strawberry Mansion Health Center

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1417064353

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 9

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1427165307

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 5

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1518074566

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Phila Health Dept Laboratory

    • Clinical Medical Laboratory
    • Phila, PA
    • NPI 1689688798

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Center 10

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1699882597

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 2

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1942317094

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Marisa A Rogers, MD
    • Internal Medicine Physician
    • Birmingham, AL
    • NPI 1336171628

    Corporate Director

    CMS ownership

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Department of Public Health - Philadelphia District HC #2Philadelphia, PA, CCN 391872 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 2015
Department of Public Health - Strawberry Mansion Health CenterPhiladelphia, PA, CCN 391879 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1985
Department of Public Health - Philadelphia District Health Center #10Philadelphia, PA, CCN 391878 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1976
Department of Public Health - Philadelphia District HC #9Philadelphia, PA, CCN 391877 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Department of Public Health - Philadelphia District HC #6Philadelphia, PA, CCN 391876 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1984
Department of Public Health-Philadelphia District Health Center #4Philadelphia, PA, CCN 391874 Federally qualified health center Operational/Managerial Control Feb 24, 2011
Department of Public Health-Philadelphia District HC #5Philadelphia, PA, CCN 391875 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 2, 1980

Owned or controlled facilities with NPI records 7

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

  • City of Philadelphia

    dba Health Care Center 6

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1023125085

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 4

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1144337189

    Operational/Managerial Control

    CMS ownership
  • City of Philadelphia

    dba Strawberry Mansion Health Center

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1417064353

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 9

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1427165307

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 5

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1518074566

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Center 10

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1699882597

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • City of Philadelphia

    dba Health Care Center 2

    • Federally Qualified Health Center (FQHC)
    • Philadelphia, PA
    • NPI 1942317094

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575331200000",
    "number": "1740397769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MARKET ST FL 10",
            "address_2": "REVENUE MANAGEMENT",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191072911",
            "telephone_number": "215-685-5306",
            "fax_number": "215-685-6848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 S 43RD ST",
            "address_2": "HEALTH CARE CENTER 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044408",
            "telephone_number": "215-685-7522",
            "fax_number": "215-685-6848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF PHILADELPHIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2019-12-03",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "215-685-6843"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000076950009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "66692",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGH MARK BLUE SHIELD",
            "identifier": "66692",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100083",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G0004744",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Care Center 3",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Care Center 3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.