NPIMap

Organization Active NPI

Scranton Primary Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Scranton, PA
National Provider Identifier
1801871579
Registry record updated Oct 1, 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
959 Wyoming Ave
Scranton, PA 18509-3023
Phone
(570) 344-3517
Fax
(570) 344-6839
NPI assigned
Dec 14, 2005
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
Joseph H Hollander
Title
Ceo
Phone
(570) 344-3517

Specialties & licenses 1

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

Addresses

Primary practice location

959 Wyoming Ave
Scranton, PA 18509-3023

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1007288710003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, WI2 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
Practice locations: Scranton, PA
O20100816000071 WI 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 1801871579. Details of each certification follow.

Federally qualified health center certification: CCN 391815

Legal name
SCRANTON PRIMARY HEALTH CARE CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1976 in PA
Enrollment address
959 Wyoming Ave
Scranton, PA 18509-3023

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
39D0885792Scranton Primary Health Care Center959 Wyoming Avenue, Scranton, PA 18509Provider-performed microscopyMay 2, 2028

National Provider Directory

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

Other organizations with this tax ID 1

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

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 Employee Jan 1, 2014
Joseph H Hollander Individual Corporate DirectorCeo Jan 1, 2014
W-2 Managing EmployeeCeo Jan 1, 2014 100%
Paula a Keenan Individual W-2 Managing Employee Jan 14, 2014
David Gibson Individual Corporate OfficerBoard Secrtetary-Treasurer Nov 25, 2014
Corporate DirectorBoard Member-Secretary-Treasurer Nov 25, 2014
Richard Jones Individual Corporate OfficerBoard President Nov 25, 2014
Corporate DirectorBoard President Nov 25, 2014
James L Sundheim Individual Corporate OfficerBoard Vice President Nov 25, 2014
Corporate DirectorBoard Member-Vice President Nov 25, 2014

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1801871579",
    "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": "570-344-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 WYOMING AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185093023",
            "telephone_number": "570-344-3517",
            "fax_number": "570-344-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCRANTON PRIMARY HEALTH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-14",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "HOLLANDER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-344-3517"
    },
    "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": "1007288710003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.