NPIMap

Organization Active NPI

Community Health Net

  • Federally Qualified Health Center (FQHC)
  • Erie, PA
National Provider Identifier
1972826626
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH NET
Practice address
4401 Iroquois Ave
Erie, PA 16511-2219
Phone
(814) 455-7222
Fax
(814) 459-6678
NPI assigned
Mar 9, 2010
Last updated
Mar 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Authorized official

Name
Craig A Ulmer
Title
Ceo
Phone
(814) 454-4530

Specialties & licenses 1

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

Addresses

Primary practice location

4401 Iroquois Ave
Erie, PA 16511-2219

Mailing address

PO Box 369
Erie, PA 16512-0369
Phone (814) 454-4530

Other identifiers 1

IdentifierTypeStateIssuer
100754307-0052MedicaidPA

Other names 1

  • HARBORCREEK HEALTH CENTER Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000617 PA Part B Supplier - Clinic/Group Practice 1759290588 Receives reassigned benefits from 29 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harborcreek, PA; Erie, PA; Girard, PA
O20120316000400 PA Part A Provider - Federally Qualified Health Center (FQHC) 1759290588 Practice locations: Erie, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972826626. Details of each certification follow.

Federally qualified health center certification: CCN 391024

Legal name
COMMUNITY HEALTH NET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 26, 2012
Last certification
Mar 26, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 25, 1985 in PA
Enrollment address
4401 Iroquois Avenue
Community Health Net
Erie, PA 16511-2219

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

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
39D2048136Harborcreek Health Center4401 Iroquois Avenue, Erie, PA 16511Certificate of waiverOct 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community Health Net6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Phil Cardella Individual Corporate OfficerChief Financial Officer Feb 1, 2022
W-2 Managing EmployeeChief Financial Officer Feb 1, 2022
Operational/Managerial ControlChief Financial Officer Feb 1, 2022
Craig Ulmer Individual Corporate OfficerCeo Apr 10, 2017
W-2 Managing EmployeeCeo Apr 10, 2017
Operational/Managerial ControlCeo Apr 10, 2017
Linda Pinnell Individual W-2 Managing EmployeeCompliance Analyst Jan 11, 2019
Anthony R Ignocheck Individual Corporate DirectorMedical Director Oct 1, 2015

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 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1972826626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165120369",
            "telephone_number": "814-454-4530",
            "fax_number": "814-456-2375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 IROQUOIS AVE",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165112219",
            "telephone_number": "814-455-7222",
            "fax_number": "814-459-6678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH NET",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "ULMER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-454-4530"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100754307-0052",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HARBORCREEK HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HARBORCREEK HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.