NPIMap

Organization Active NPI

Wayne Memorial Community Health Centers

Doing business as Hamlin Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Lake Ariel, PA
National Provider Identifier
1780820068
Registry record updated Aug 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Doing business as
Hamlin Family Health Center
Practice address
543 Easton Tpke
Suite 105
Lake Ariel, PA 18436-4798
Phone
(570) 689-9965
Fax
(570) 689-0387
NPI assigned
Dec 17, 2008
Last updated
Aug 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2020

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

Authorized official

Name
Frederick Jackson
Title
Executive Director
Phone
(570) 253-8450

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X PA Primary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X

Addresses

Primary practice location

543 Easton Tpke
Suite 105
Lake Ariel, PA 18436-4798

Mailing address

601 Park St
Honesdale, PA 18431-1445
Phone (570) 689-9965

Other names 1

  • HAMLIN 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
O20090106000280 PA Part A Provider - Federally Qualified Health Center (FQHC) 3072598937 Practice locations: Lake Ariel, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780820068. Details of each certification follow.

Federally qualified health center certification: CCN 391985

Legal name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2009
Last certification
Feb 26, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in PA
Enrollment address
543 Easton Tpke
Lake Ariel, PA 18436-4798

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
39D0883764Hamlin Family Health Center543 Easton Turnpike Suite 105, Lake Ariel, PA 18436Certificate of waiverMar 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hamlin Family Health Center27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

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
Carrie Demers Individual Corporate Director May 1, 2012
Michelle Louise Wonders Individual Corporate DirectorSecretary May 1, 2018
Patricia Dunsinger Individual Corporate DirectorTreasurer Feb 1, 2019
Steven Guccini Individual Corporate Director Feb 1, 2022
Gregory Capitolo Individual Corporate DirectorVice Chairman Feb 1, 2019
William Kerl Individual Corporate Director May 1, 2012
Steve Tourje Individual Corporate Director May 1, 2012
Robert Fortuner Individual Corporate Director Feb 1, 2015
W-2 Managing Employee Feb 1, 2015
James Pettinato Individual Corporate Director Dec 1, 2021
David Hoff Individual Corporate Director Sep 1, 2007
Teresa Lacey Individual Corporate DirectorCeo Feb 1, 2023
W-2 Managing EmployeeCeo Feb 1, 2023

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 4

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": "1229472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1780820068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 PARK ST",
            "city": "HONESDALE",
            "state": "PA",
            "postal_code": "184311445",
            "telephone_number": "570-689-9965",
            "fax_number": "570-689-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "543 EASTON TPKE",
            "address_2": "SUITE 105",
            "city": "LAKE ARIEL",
            "state": "PA",
            "postal_code": "184364798",
            "telephone_number": "570-689-9965",
            "fax_number": "570-689-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEMORIAL COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-17",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-253-8450"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAMLIN FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HAMLIN FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Ariel, PA

Sources for this page

Verify at the official NPI Registry.