NPIMap

Organization Active NPI

Scranton Primary Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Scranton, PA
National Provider Identifier
1801336458
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SCRANTON PRIMARY HEALTH CARE CENTER, INC.
Practice address
425 Alder St
Scranton, PA 18505-4126
Phone
(570) 955-5524
Fax
(570) 354-2113
NPI assigned
Mar 1, 2017
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SCRANTON PRIMARY HEALTH CARE CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Mr. Joseph H Hollander
Title
Executive Director
Phone
(570) 344-3517

Specialties & licenses 1

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

Addresses

Primary practice location

425 Alder St
Scranton, PA 18505-4126

Mailing address

959 Wyoming Ave
Scranton, PA 18509-3023
Phone (570) 344-3517

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061019000363 PA Part B Supplier - Clinic/Group Practice 0941206650 Receives reassigned benefits from 30 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Scranton, PA
O20180109001937 PA Part A Provider - Federally Qualified Health Center (FQHC) 0941206650 Practice locations: Scranton, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801336458. Details of each certification follow.

Federally qualified health center certification: CCN 391101

Legal name
SCRANTON PRIMARY HEALTH CARE CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 2, 2018
Last certification
Jan 2, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1976 in PA
Enrollment address
425 Alder St
Scranton, PA 18505-4116

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 2

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

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
39D2133639Scranton Primary Health Care Center, Inc425 Alder Street, Scranton, PA 18505Certificate of waiverJul 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Green Ridge Primary Car2 organizations share this tax ID, including this one
Part of
Green Ridge Primary Car

Other organizations with this tax ID 1

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

Locations

425 Alder St
Scranton, PA 18505
Phone (570) 346-0759

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Robert D Barber Individual W-2 Managing EmployeeCfo May 22, 2022
Joseph H Hollander Individual Corporate DirectorCeo May 25, 2022 100%
W-2 Managing EmployeeAd;Ceo May 25, 2022 100%
Paula a Keenan Individual W-2 Managing EmployeeChief Nursing Officer May 25, 2022
David Gibson Individual Corporate DirectorGoverning Board Member Sceretary May 25, 2022
Richard Jones Individual Corporate DirectorBoard Member Governing Board Pre May 20, 2022
James L Sundheim Individual Corporate DirectorGoverning Board Member Vice Pres May 25, 2022

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1801336458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "959 WYOMING AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185093023",
            "telephone_number": "570-344-3517",
            "fax_number": "570-344-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 ALDER ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185054126",
            "telephone_number": "570-955-5524",
            "fax_number": "570-354-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCRANTON PRIMARY HEALTH CARE CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCRANTON PRIMARY HEALTH CARE CENTER, INC.",
        "enumeration_date": "2017-03-01",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "HOLLANDER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-344-3517",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.