NPIMap

Organization Active NPI

Primary Care Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Pittsburgh, PA
National Provider Identifier
1760552129
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE HEALTH SERVICES, INC
Practice address
4918 2ND Ave
Pittsburgh, PA 15207-1623
Phone
(412) 422-9520
Fax
(412) 422-4094
NPI assigned
Nov 9, 2006
Organization subpart
Yes
Parent organization
PRIMARY CARE HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Authorized official

Name
Wilford A. Payne
Title
Executive Director
Phone
(412) 244-4700

Specialties & licenses 1

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

Addresses

Primary practice location

4918 2ND Ave
Pittsburgh, PA 15207-1623

Mailing address

7227 Hamilton Ave
Pittsburgh, PA 15208-1814
Phone (412) 244-4700

Other names 1

  • Hazelwood Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101124000644 PA Part A Provider - Federally Qualified Health Center (FQHC) 7012825722 Practice locations: Pittsburgh, PA

Federally qualified health center certification: CCN 391917

Legal name
PRIMARY CARE HEALTH SERVICES, INC.
Doing business as
HAZELWOOD HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2003
Last certification
Mar 10, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1977 in PA
Enrollment address
4918 2ND Ave
Pittsburgh, PA 15207-1623

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0177179Hazelwood Family Health Center4918 Second Avenue, Pittsburgh, PA 15207Provider-performed microscopyMar 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Health SVC16 organizations share this tax ID, including this one
Part of
Primary Care Health SVC

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Ronald Thornhill Individual Corporate Director Sep 27, 2010
Tawnya R. Farris Individual Corporate Director Sep 27, 2010
Carolyn Vera Callahan Individual Corporate Director Sep 27, 2010
John Hollis Individual W-2 Managing EmployeeCoo/ Finance Director Sep 1, 2019
Operational/Managerial Control Sep 1, 2019
Judith Ginyard Individual Corporate Director Sep 10, 2010
Lea Blumenfeld Individual Corporate Director Sep 10, 2010
Jerome E Gloster Individual Corporate OfficerCeo Apr 1, 2019
W-2 Managing EmployeeCeo Apr 1, 2019
Richard M. Adams Individual Corporate Director Sep 27, 2010

Owners & managing parties with NPI records 1

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1760552129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 HAMILTON AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152081814",
            "telephone_number": "412-244-4700",
            "fax_number": "412-244-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4918 2ND AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152071623",
            "telephone_number": "412-422-9520",
            "fax_number": "412-422-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE HEALTH SERVICES, INC.",
        "enumeration_date": "2006-11-09",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "WILFORD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "412-244-4700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazelwood Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.