NPIMap

Organization Active NPI

Scranton Primary Health Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Scranton, PA
National Provider Identifier
1841709623
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
406 N Washington Ave
Scranton, PA 18503-1306
Phone
(570) 344-9684
NPI assigned
Sep 25, 2017
Last updated
Oct 1, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SCRANTON PRIMARY HEALTH CARE CENTER, INCAs reported in NPPES

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
Mr. 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

406 N Washington Ave
Scranton, PA 18503-1306

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1007288710010MedicaidPA

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841709623. Details of each certification follow.

  • CCN 391158 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 391158

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SCRANTON PRIMARY HEALTHCARE CENTER INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 7, 2020
Last certification
Feb 7, 2020
Ownership / control type
For profit – corporation
Facility address
406 N, Washington Ave
Scranton, PA 18503

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
39D2239966Scranton Primary Health Care Center Inc406 N Washington Ave, Scranton, PA 18503Certificate of waiverOct 14, 2027

National Provider Directory

National Provider Directory
Part of
Green Ridge Primary Car

Locations

406 N Washington Ave
Scranton, PA 18503
Phone (570) 344-9684

Ownership & related parties

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 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1841709623",
    "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": "406 N WASHINGTON AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185031306",
            "telephone_number": "570-344-9684"
        }
    ],
    "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": "2017-09-25",
        "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",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288710010",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Scranton, PA

Sources for this page

Verify at the official NPI Registry.