NPIMap

Organization Active NPI

Philadelphia Dept. of Public Health

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1821172107
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PHILADELPHIA DEPT. OF PUBLIC HEALTH
Practice address
1101 Market St FL 12
Philadelphia, PA 19107
Phone
(215) 685-6843
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Christine Gaddy
Title
Billing Manager
Phone
(215) 685-6843

Specialties & licenses 1

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

Addresses

Primary practice location

1101 Market St FL 12
Philadelphia, PA 19107

Mailing address

1101 Market St FL 12
Philadelphia, PA 19107-2934
Phone (215) 685-6843

Other identifiers 1

IdentifierTypeStateIssuer
1000076950008MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000911 PA Part B Supplier - Clinic/Group Practice 6305758723 Receives reassigned benefits from 163 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Tax ID family
Health Center 223 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

1101 Market St
Fl 12
Philadelphia, PA 19107
Phone (215) 685-6843

Ownership & related parties

Other NPIs on the same Medicare enrollment 8

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

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1821172107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MARKET ST FL 12",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191072934",
            "telephone_number": "215-685-6843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MARKET ST FL 12",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19107",
            "telephone_number": "215-685-6843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILADELPHIA DEPT. OF PUBLIC HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "GADDY",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "215-685-6843"
    },
    "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": "1000076950008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.