NPIMap

Organization Active NPI

Greater Philadelphia Health Action Inc.

Doing business as GPHA Woodland Avenue Health Center

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
National Provider Identifier
1952356867
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREATER PHILADELPHIA HEALTH ACTION INC.
Doing business as
GPHA Woodland Avenue Health Center
Practice address
5000 Woodland Ave
Philadelphia, PA 19143-5137
Phone
(215) 726-9807
Fax
(215) 726-0424
NPI assigned
May 23, 2006
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Authorized official

Name
Ms. D. Tina Smith
Title
Provider Enrollment Spec.
Phone
(215) 925-2400

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Midwife 176B00000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X
Podiatrist 213E00000X
Child Abuse Pediatrics Physician 2080C0008X

Addresses

Primary practice location

5000 Woodland Ave
Philadelphia, PA 19143-5137

Mailing address

1401 S 31St St
2ND Floor
Philadelphia, PA 19146-3506
Phone (215) 925-2400

Other identifiers 1

IdentifierTypeStateIssuer
1001374480052MedicaidPA

Other names 1

  • GPHA Woodland Avenue Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040227000863 PA Part A Provider - Federally Qualified Health Center (FQHC) 9537064977 Practice locations: Philadelphia, PA
O20110602000389 PA Part B Supplier - Clinic/Group Practice 9537064977 Receives reassigned benefits from 242 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, PA; Philadelphia, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952356867. Details of each certification follow.

Federally qualified health center certification: CCN 391802

Legal name
GREATER PHILADELPHIA HEALTH ACTION INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1986 in PA
Enrollment address
5000 Woodland Ave
Philadelphia, PA 19143-5137

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 11

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
39D0924217Gpha Woodland Avenue Health Center5000 Woodland Avenue, Philadelphia, PA 19143Provider-performed microscopyJul 22, 2028

National Provider Directory

National Provider Directory
Tax ID family
Greater Philadelphia Health39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Claire a Washington Individual Corporate OfficerBoard Member Mar 1, 2001
Corporate Director Mar 1, 2010
Celeste Johns Individual Corporate DirectorReimbursement Director Jun 23, 2008
Janice a Smith Individual Corporate OfficerBoard Member Mar 1, 1979
Corporate Director Mar 1, 1979
Valerie E Tuck Individual Corporate OfficerBoard Member Mar 1, 2015
Roger C Collins Individual Corporate OfficerBoard Member/ Assistant Treasure Mar 1, 1979
Corporate Director Mar 1, 1979
Stephen R Cox Individual Corporate OfficerBoard Member Mar 1, 2000
Royal E Brown Individual Corporate OfficerBoard Member/Chair Person Mar 1, 1988
Corporate Director Mar 1, 1988
Brian Clark Individual Corporate OfficerCeo, Executive Director Jan 1, 2018
Corporate DirectorCeo, Executive Director Jan 1, 2018
W-2 Managing EmployeeCeo, Executive Director Jan 1, 2018
Sandra Hawkins-Dorsey Individual Corporate OfficerSecretary Mar 1, 2004
Minnie Moore-Johnson Individual Corporate OfficerMember May 1, 2020
Flora M Castillo Individual Corporate OfficerBoard Member Mar 1, 2008
Linda W Powell Individual Corporate OfficerBoard Member/Chair Person Mar 1, 2004
Phyllis H Detwiler Individual Corporate OfficerBoard Member Mar 1, 2012
Paula D Jackson Individual Corporate OfficerBoard Member/Corporate Secretary Mar 1, 1993
Corporate Director Mar 1, 1993

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1952356867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S 31ST ST",
            "address_2": "2ND FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191463506",
            "telephone_number": "215-925-2400",
            "fax_number": "215-925-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 WOODLAND AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191435137",
            "telephone_number": "215-726-9807",
            "fax_number": "215-726-0424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PHILADELPHIA HEALTH ACTION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "D.",
        "authorized_official_middle_name": "TINA",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT SPEC.",
        "authorized_official_telephone_number": "215-925-2400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001374480052",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GPHA Woodland Avenue Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.