NPIMap

Organization Active NPI

East Liberty Family Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pittsburgh, PA
National Provider Identifier
1760642896
Registry record updated May 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Practice address
6023 Harvard SQ
Pittsburgh, PA 15206-3053
Phone
(412) 661-2802
Fax
(412) 661-8020
NPI assigned
Jun 12, 2008
Last updated
May 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2015

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

Authorized official

Name
Rodney Jones Sr.
Title
Ceo
Phone
(412) 362-6353

Specialties & licenses 1

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

Addresses

Primary practice location

6023 Harvard SQ
Pittsburgh, PA 15206-3053

Mailing address

6023 Harvard SQ
Pittsburgh, PA 15206-3053
Phone (412) 661-2802

Other identifiers 1

IdentifierTypeStateIssuer
1007524920001MedicaidPA

Other names 1

  • East Liberty Family Health Care Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040825000501 PA Part B Supplier - Clinic/Group Practice 2163496084 Receives reassigned benefits from 56 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pittsburgh, PA
O20110105001291 PA Part A Provider - Federally Qualified Health Center (FQHC) 2163496084 Practice locations: Pittsburgh, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760642896. Details of each certification follow.

Federally qualified health center certification: CCN 391871

Legal name
EAST LIBERTY FAMILY HEALTH CARE CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 1994
Last certification
Nov 1, 1994
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Jan 4, 1982 in PA
Enrollment address
6023 Harvard Square
Pittsburgh, PA 15206-3053

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

6023 Harvard St
Ste 2
Pittsburgh, PA 15206

7157 Mary Peck Bond Pl
Pittsburgh, PA 15206
Phone (412) 345-0412

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Kristen Wilson Individual Corporate Director Feb 21, 2006
Andrew Pernesky Individual Corporate Officer Aug 10, 2015
Alice Keister Individual W-2 Managing Employee Apr 4, 2016
Sean Michael Conroy Individual Corporate Director Aug 27, 2012
Kathy Mayle-Towns Individual Corporate Director Feb 15, 2010
Steve Paff Individual Corporate Director Aug 25, 2014
Angelica Cooper Individual Corporate Director Aug 25, 2014
Abimbola Fapohunda Individual Corporate Director Mar 1, 2017
David George Hall Individual Corporate DirectorMedical Director Jul 1, 1982
Rodney B Jones Individual Corporate OfficerChief Executive Officer May 4, 2015
Corporate DirectorChief Executive Officer May 4, 2015
Operational/Managerial Control May 4, 2015
Michael Smith Individual Corporate Director Aug 25, 2014
Mark Richardson Individual Corporate Director Jul 1, 2015
Paul Roberts Individual Corporate Director Nov 5, 2010
Diana Armstrong Individual Corporate Director Sep 23, 2013
Michael Wherry Individual Corporate Director Feb 20, 2008
Mattie Woods Individual Corporate Director Jul 1, 2012
Georgette Powell Individual Corporate Director Nov 5, 2010

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 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1760642896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6023 HARVARD SQ",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152063053",
            "telephone_number": "412-661-2802",
            "fax_number": "412-661-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6023 HARVARD SQ",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152063053",
            "telephone_number": "412-661-2802",
            "fax_number": "412-661-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-12",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "412-362-6353",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007524920001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Liberty Family Health Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.