NPIMap

Organization Active NPI

Southbridge Medical Advisory Council, Inc.

Doing business as Henrietta Johnson Medical Center Claymont

  • Federally Qualified Health Center (FQHC)
  • Claymont, DE
National Provider Identifier
1760874549
Registry record updated May 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.
Doing business as
Henrietta Johnson Medical Center Claymont
Practice address
2722 Philadelphia Pike
Claymont, DE 19703-2568
Phone
(302) 655-6187
Fax
(302) 798-2473
NPI assigned
Mar 3, 2015
Last updated
May 21, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2019

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

Authorized official

Name
Ms. Nachet Scott
Title
Ceo
Phone
(026) 593-0773

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2722 Philadelphia Pike
Claymont, DE 19703-2568

Mailing address

2722 Philadelphia Pike
Claymont, DE 19703-2568
Phone (026) 556-1873

Other identifiers 1

IdentifierTypeStateIssuer
440009OtherDEMEDICARE PROVIDER TRANSACTION ACCESS NUMBER

Other names 1

  • Henrietta Johnson Medical Center Claymont Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040514000340 DE Part B Supplier - Clinic/Group Practice 8426967928 Receives reassigned benefits from 12 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Claymont, DE; Wilmington, DE
O20160209001878 DE Part A Provider - Federally Qualified Health Center (FQHC) 8426967928 Practice locations: Claymont, DE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760874549. Details of each certification follow.

Federally qualified health center certification: CCN 081816

Legal name
SOUTHBRIDGE MEDICAL ADVISORY COUNCIL INC
Doing business as
HENRIETTA JOHNSON MED CENTER @CLAYMONT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 22, 2015
Last certification
Dec 22, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 8, 1969 in DE
Enrollment address
2722 Philadelphia Pike
Claymont, DE 19703-2568

Other NPIs with the same Medicare PAC ID 1

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
Part of
Henrietta Johnson Med Ctr

Locations

2722 Philadelphia Pike
Claymont, DE 19703
Phone (302) 655-6187

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Nachet Scott Individual Corporate DirectorCeo Jan 26, 2018
W-2 Managing EmployeeCeo Jan 26, 2018
Martha Beard Individual Corporate DirectorBoard Member Oct 31, 2024
Michele Gladney Individual Corporate DirectorBoard Member Oct 31, 2024
Monique Barrett Individual Corporate DirectorBoard Member Oct 31, 2024
Yvette N Gbemudu Individual Corporate DirectorCmo Jan 5, 2015
W-2 Managing EmployeeCmo Jan 5, 2015
Howard K Barnes Individual Corporate OfficerBoard Member Aug 1, 2015
Nancy Scott Individual Corporate OfficerBoard Chair Aug 1, 2015

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 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1760874549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2722 PHILADELPHIA PIKE",
            "city": "CLAYMONT",
            "state": "DE",
            "postal_code": "197032568",
            "telephone_number": "026-556-1873",
            "fax_number": "027-982-4733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 PHILADELPHIA PIKE",
            "city": "CLAYMONT",
            "state": "DE",
            "postal_code": "197032568",
            "telephone_number": "302-655-6187",
            "fax_number": "302-798-2473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHBRIDGE MEDICAL ADVISORY COUNCIL, INC.",
        "enumeration_date": "2015-03-03",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "NACHET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "026-593-0773",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER",
            "identifier": "440009",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henrietta Johnson Medical Center Claymont",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henrietta Johnson Medical Center Claymont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Claymont, DE

Sources for this page

Verify at the official NPI Registry.