NPIMap

Organization Active NPI

Public Health Management Corporation

  • Community/Behavioral Health Agency
  • Philadelphia, PA
National Provider Identifier
1932245099
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
807285 Issued in PA
Legal business name
PUBLIC HEALTH MANAGEMENT CORPORATION
Practice address
4108 Parkside Avenue
Philadelphia, PA 19102
Phone
(215) 871-0300
Fax
(215) 477-0244
NPI assigned
Jan 29, 2007
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Authorized official

Name
Mr. Richard J Cohen, PHD
Title
President
Phone
(215) 985-2501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 807285 PA Primary

Addresses

Primary practice location

4108 Parkside Avenue
Philadelphia, PA 19102

Mailing address

1500 Market St FL East17
Philadelphia, PA 19102-2100
Phone (215) 985-2500

Other names 1

  • Interim House West Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060504000213 PA Part B Supplier - Clinic/Group Practice 1850307406 Receives reassigned benefits from 109 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Philadelphia, PA; Flourtown, PA
O20200213002103 PA Part A Provider - Federally Qualified Health Center (FQHC) 1850307406 Practice locations: Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932245099. Details of each certification follow.

Federally qualified health center certification: CCN 731808

Legal name
PUBLIC HEALTH MANAGEMENT CORPORATION
Doing business as
PUBLIC HEALTH MANAGEMENT CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2020
Last certification
Feb 11, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2019 in PA
Enrollment address
4108 Parkside Ave
Philadelphia, PA 19104-1020

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Varsovia Fernandez Individual Corporate DirectorBoard Member Jan 1, 2018
Patrick Eiding Individual Corporate DirectorBoard Member Jan 1, 2002
Judy Gay Individual Corporate DirectorBoard Member Jan 1, 2016
Leonard Marcus Allen Individual Corporate DirectorBoard Member Jan 1, 2018
Michelle Grey Individual Corporate DirectorBoard Member Jan 1, 2019
Stephen P Fera Individual Corporate OfficerTreasurer Jun 20, 2019
Corporate DirectorBoard Member Jan 1, 2007
Kenneth J Veit Individual Corporate DirectorBoard Member Jan 1, 1988
Koren Allyson Bedeau Individual Corporate DirectorBoard Member Jan 1, 2019
Kathleen Kinslow Individual Corporate DirectorBoard Member Jan 1, 2012
James Oram Individual Corporate DirectorBoard Member Jan 1, 2013
Theodore a. Christopher Individual Corporate DirectorBoard Member Jan 1, 2009
Treerita Johnson-Greene Individual Corporate DirectorBoard Member Jan 1, 2019
Frank Killian Individual Corporate DirectorDirector of Finance Sep 20, 2015
W-2 Managing EmployeeDirector of Finance Sep 20, 2015
Sophia Lee Individual Corporate OfficerSecretary Jun 20, 2019
Corporate DirectorBoard Member Jan 1, 2018
Keith Leaphart Individual Corporate DirectorBoard Member Jan 1, 2016
Dinetta Armstrong Individual W-2 Managing Employee Sep 20, 2015
Kathleen Matt Individual Corporate DirectorBoard Member Jan 1, 2019
Michael Pearson Individual Corporate OfficerImmediate Past Chair Jun 20, 2019
Corporate DirectorBoard Member Jan 1, 2008
George E Downs Individual Corporate DirectorBoard Member Jan 1, 2005
Paschal Nwako Individual Corporate DirectorBoard Member Jan 1, 2019
Richard J Cohen Individual Corporate OfficerPresident Jun 20, 2019
Samuel Patterson Individual Corporate OfficerChairman Jun 20, 2019
Corporate DirectorBoard Member Jan 1, 2016
Allison Davenport Individual Corporate DirectorBoard Member Jan 1, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
PHMC Health Center on Cedar AvenuePhiladelphia, PA, CCN 731950 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1932245099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 MARKET ST FL EAST17",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022100",
            "telephone_number": "215-985-2500",
            "fax_number": "267-765-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4108 PARKSIDE AVENUE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19102",
            "telephone_number": "215-871-0300",
            "fax_number": "215-477-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIC HEALTH MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-985-2501",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "807285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interim House West",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Interim House West",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.