NPIMap

Organization Active NPI

Primary Care Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pittsburgh, PA
National Provider Identifier
1891865291
Registry record updated Oct 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CARE HEALTH SERVICES, INC.
Practice address
807 Wallace Ave
Pittsburgh, PA 15221-2312
Phone
(412) 247-5216
Fax
(412) 247-5296
NPI assigned
Nov 9, 2006
Organization subpart
Yes
Parent organization
PRIMARY CARE HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2010

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

Authorized official

Name
Mr. Wilford A. Payne
Title
Executive Director
Phone
(412) 244-4700

Specialties & licenses 1

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

Addresses

Primary practice location

807 Wallace Ave
Pittsburgh, PA 15221-2312

Mailing address

7227 Hamilton Ave
Pittsburgh, PA 15208-1814
Phone (412) 244-4700

Other names 1

  • Wilkinsburg Family Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101124000885 PA Part A Provider - Federally Qualified Health Center (FQHC) 7012825722 Practice locations: Wilkinsburg, PA

Federally qualified health center certification: CCN 391868

Legal name
PRIMARY CARE HEALTH SERVICES, INC.
Doing business as
WILKINSBURG FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 22, 1994
Last certification
Sep 22, 1994
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1977 in PA
Enrollment address
807 Wallace Ave
Wilkinsburg, PA 15221-2312

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
39D0911484Wilkinsburg Family Health Center807 Wallace Ave - Hosanna House Ste 203, Pittsburgh, PA 15221Provider-performed microscopyFeb 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Primary Care Health SVC16 organizations share this tax ID, including this one
Part of
Primary Care Health SVC

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Tawnya R. Farris Individual Corporate Director Sep 27, 2010
Carolyn Vera Callahan Individual Corporate Director Sep 27, 2010
John Hollis Individual W-2 Managing Employee Apr 1, 2019
Operational/Managerial Control Sep 1, 2019
Judith Ginyard Individual Corporate Director Sep 27, 2010
Lea Blumenfeld Individual Corporate Director Feb 19, 2019
Jerome E Gloster Individual Corporate Director Sep 1, 2018
W-2 Managing Employee Apr 1, 2019
Richard M. Adams Individual Corporate Director Sep 27, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1891865291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7227 HAMILTON AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152081814",
            "telephone_number": "412-244-4700",
            "fax_number": "412-244-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 WALLACE AVE",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152212312",
            "telephone_number": "412-247-5216",
            "fax_number": "412-247-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CARE HEALTH SERVICES, INC.",
        "enumeration_date": "2006-11-09",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "WILFORD",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "412-244-4700",
        "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": [
        {
            "organization_name": "Wilkinsburg Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

Verify at the official NPI Registry.