Sayre Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Philadelphia, PA
NPI 1831209113 · NPPES record last updated Jun 20, 2012
Key facts
- NPI
- 1831209113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SAYRE HEALTH CENTER
- Practice address
- 5800 Walnut Street Rear
Philadelphia, PA 19139 - Phone
- (215) 474-4444
- Fax
- (215) 474-6021
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Kent Bream, MD
- Title
- Medical Director
- Phone
- (215) 474-4411
Practitioners 35
-
Peter F Fischbeck, LCSW
-
Ann Ilufoye, CRNP
-
Antoinette Pierre, FNP
-
Shagufta Ahsan, MD
-
J Francis Asuquo, M.D., D.O., MPH
-
Johnnie Marie Berry, LCSW
-
Dwane Quincy Budheah, LSW
-
Jacque Curtis, M.D.
-
Joseph Francis Girone, M.D.
-
Kimberly Gray, MBA, MSS, MLSP, LCSW
-
Paula C Patton, MD
-
Maudeline Paul, NP
-
Phebena Rency, NP
-
Candace Williams, NP
-
Melissa Gail Williams, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D1059431 | Sayre Health Center | Provider-performed microscopy | Sep 28, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in PA
Federally qualified health center certification: CCN 391969
- Legal name
- SAYRE HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 23, 2007
- Last certification
- Jan 23, 2007
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 7, 2004 in PA
- Enrollment address
- 5800 Walnut St Rear
Philadelphia, PA 19139-3836
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa M Lewis |
Corporate Director |
Mar 17, 2011 | |
| Tanya M Thompson |
Corporate Director |
Oct 15, 2009 | |
| Nancy Winder |
Corporate Director |
Jun 26, 2006 | |
| Cory Bowman |
Corporate Director |
Jun 26, 2006 | |
| Frederick M Carey |
Corporate Officer |
Dec 30, 2009 | 100% |
| W-2 Managing Employee |
Dec 30, 2009 | 100% | |
| Patricia L. Bell |
Corporate Director |
Sep 19, 2013 | |
| Shonte Eley |
Corporate Director |
May 15, 2014 | |
| Mary-Martha Johnson |
Corporate Director |
Sep 15, 2011 | |
| Tonya R Robinson |
Corporate Director |
Oct 15, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061114000505 | PA | Part a Provider - Federally Qualified Health Center (FQHC) | 7416955000 | Practice locations: Philadelphia, PA |
| O20220317002858 | PA | Part B Supplier - Clinic/Group Practice | 7416955000 |
Receives reassigned benefits from 27 practitioners Practice locations: Philadelphia, PA |
National Provider Directory
Locations
5800 Walnut St
Rear
Philadelphia, PA 19139
Phone (215) 474-4444
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73304
- https://fhir4.healow.com/fhir/r4/CHJCDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
5800 Walnut Street Rear
Philadelphia, PA 19139
Mailing address
5800 Walnut Street Rear
Philadelphia, PA 19139-3836
Phone (215) 474-4411
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1019704400001 | Medicaid | PA |
Other providers in Philadelphia, PA
- Princess Saye
- Melissa Sayer
- Maranda Emily Sayers
- Marie G Sayers
- Steven L. Sayers
- Dean Sayre
- Patrick John Sayre
- Paul Louis Sbarra
- Kaitlyn Sbarro
- SBS Dental Associates PA LLC
All providers in Philadelphia, PA · Federally Qualified Health Center (FQHC) in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.