Family Health Clinic Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FAMILY HEALTH CLINIC INC

Doing business as

Susquehanna Family Health Clinic Inc

Practice address

401 Broad Ave
Susquehanna, PA 18847-1611

Phone

(570) 853-3995

Fax

(570) 853-3728

NPI assigned

Jul 15, 2006

Last updated

Jan 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Warren S Dewitt, MDNPI 1245328145

Title

Owner

Phone

(570) 853-3995

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Susquehanna Family Health Clinic Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in PA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972529543. Details of each certification follow.

• CCN 393926 Rural health clinic · Active · Details

Rural health clinic certification: CCN 393926

Legal name

FAMILY HEALTH CLINIC, INC.

Doing business as

SUSQUEHANNA FAMILY HEALTH CLINIC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 2, 2021

Last certification

Sep 2, 2021

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Feb 20, 1990 in PA

Enrollment address

401 Broad Avenue
Susquehanna, PA 18847-1611

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 2

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

• Kathryn Nellie Dewitt

  • Family Nurse Practitioner
  • Susquehanna, PA
  • NPI 1821572660

  Corporate Officer, Operational/Managerial Control

  CMS ownership
• Warren Dewitt, MD

  • Family Medicine Physician
  • Susquehanna, PA
  • NPI 1245328145

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 5

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.

• Warren Dewitt, MD

  • Family Medicine Physician
  • Susquehanna, PA
  • NPI 1245328145
  Medicare reassignment Care Compare group NPD Authorized official
• Janine Marie Dewitt, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Susquehanna, PA
  • NPI 1922774694
  Medicare reassignment Care Compare group NPD
• Kathryn Nellie Dewitt

  • Family Nurse Practitioner
  • Susquehanna, PA
  • NPI 1821572660
  Medicare reassignment Care Compare group NPD
• Nicole Ann Suhadolnik, FNP-C

  • Family Nurse Practitioner
  • Susquehanna, PA
  • NPI 1043932395
  Medicare reassignment NPD
• Amanda Victoria Greer-Arthur, CRNP

  • Family Nurse Practitioner
  • Mayfield, PA
  • NPI 1528686706
  Care Compare group

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1972529543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11",
            "city": "SUSQUEHANNA",
            "state": "PA",
            "postal_code": "188470011",
            "telephone_number": "570-853-3995",
            "fax_number": "570-853-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BROAD AVE",
            "city": "SUSQUEHANNA",
            "state": "PA",
            "postal_code": "188471611",
            "telephone_number": "570-853-3995",
            "fax_number": "570-853-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "DEWITT",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-853-3995",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "PA",
            "license": "MD024723E",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011996300001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Family Health Clinic Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janine Marie Dewitt, PMHNP
• Kathryn Nellie Dewitt
• Warren Dewitt, MD
• Paul Downton, PA-C
• Logan Lee Ellis, RDN LDN
• Ariele Garofalo, PSY.D.
• Laura Anne Goble, RD, LDN
• Judith Herschel
• William David Iveson, FNP-BC
• Nancy Koberlein, CRNP

• Rural Health Clinic/Center in Susquehanna, PA
• Providers in Susquehanna, PA by specialty
• Rural Health Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.