NPIMap

Organization Active NPI

Public Health Management Corp

Doing business as Philadelphia Health Management Corporation

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1750395653
Registry record updated Apr 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PUBLIC HEALTH MANAGEMENT CORP
Doing business as
Philadelphia Health Management Corporation
Practice address
500 Adams Avenue
Philadelphia, PA 19120-2102
Phone
(215) 279-6666
Fax
(215) 279-9674
NPI assigned
Jul 28, 2006
Last updated
Apr 11, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2012

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

Authorized official

Name
Mr. Frank Killian
Title
Director-Operations
Phone
(215) 985-2514

Specialties & licenses 1

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

Addresses

Primary practice location

500 Adams Avenue
Philadelphia, PA 19120-2102

Mailing address

260 S Broad St FL 18
Philadelphia, PA 19102-5000
Phone (215) 985-2514

Other identifiers 6

IdentifierTypeStateIssuer
G001140710OtherPAAMERICHOICE OF PA
2287757001OtherPAINDEPENDENCE BLUE CROSS
30010912OtherPAKEYSTONE MERCY
33926OtherPAHEALTH PARTNERS OF PA
001599865OtherPAPA HIGHMARK BLUE SHIELD
85942OtherPAAETNA

Other names 1

  • Philadelphia Health Management Corporation Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060307000796 PA Part A Provider - Federally Qualified Health Center (FQHC) 1850307406 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA
O20060504000213 PA Part B Supplier - Clinic/Group Practice 1850307406 Receives reassigned benefits from 109 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Flourtown, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750395653. Details of each certification follow.

Federally qualified health center certification: CCN 391954

Legal name
PUBLIC HEALTH MANAGEMENT CORPORATION
Doing business as
PHILADELPHIA HEALTH MANAGEMENT CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 7, 2006
Last certification
Apr 7, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1972 in PA
Enrollment address
5675 N Front St
Philadelphia, PA 19120-2719

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Locations

500 Adams Ave
Philadelphia, PA 19120
Phone (215) 279-9666

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Patrick Eiding Individual Corporate Director Mar 7, 2006
Denise H Christian Individual Corporate Director Jan 1, 1991
Stephen P Fera Individual Corporate OfficerSecretary Jun 1, 2015
Corporate DirectorBoard Member Jan 1, 2007
Kenneth Braithwaite Individual Corporate DirectorBoard Member Jan 1, 2007
Kenneth J Veit Individual Corporate Director Mar 7, 2006
Susan Sherman Individual Corporate Director Aug 17, 2010
Dorothy P Mann Individual Corporate Director Mar 7, 2006
Kathleen Kinslow Individual Corporate OfficerTreasurer Jun 1, 2015
Corporate DirectorBoard Member Jan 1, 2012
James Oram Individual Corporate DirectorBoard Member Jun 1, 2013
Theodore a. Christopher Individual Corporate DirectorBoard Member Jan 1, 2009
Marino a Puliti Individual W-2 Managing Employee Jan 1, 1981
Frank Killian Individual W-2 Managing Employee Feb 6, 1997
Wendell E Pritchett Individual Corporate DirectorBoard Member Jun 1, 2015
Renee Cardwell Hughes Individual Corporate DirectorBoard Member Jan 1, 2007
Sharon M Gallagher Individual Corporate Director Mar 7, 2006
Dinetta Armstrong Individual W-2 Managing Employee Sep 25, 2015
Michael Pearson Individual Corporate OfficerChairperson Jun 1, 2015
Corporate DirectorBoard Member Jan 1, 2008
George E Downs Individual Corporate DirectorBoard Member Jan 1, 2015
J Douglas Macbride Individual Corporate Director Mar 7, 2006
Curtis Schroder Individual Corporate DirectorBoard Member Jan 1, 2012
Andrew Carter Individual Corporate DirectorBoard Member Dec 1, 2014
Richard J Cohen Individual Corporate Director Mar 7, 2006

Owners & managing parties with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1750395653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 S BROAD ST FL 18",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191025000",
            "telephone_number": "215-985-2514",
            "fax_number": "267-765-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ADAMS AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202102",
            "telephone_number": "215-279-6666",
            "fax_number": "215-279-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH MANAGEMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "KILLIAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "DIRECTOR-OPERATIONS",
        "authorized_official_telephone_number": "215-985-2514",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE OF PA",
            "identifier": "G001140710",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2287757001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY",
            "identifier": "30010912",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS OF PA",
            "identifier": "33926",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA HIGHMARK BLUE SHIELD",
            "identifier": "001599865",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "85942",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Philadelphia Health Management Corporation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.