NPIMap

Organization Active NPI

Open Door Family Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brewster, NY
National Provider Identifier
1003152240
Registry record updated Dec 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5905200R Issued in NY
Legal business name
OPEN DOOR FAMILY MEDICAL CENTER, INC.
Practice address
155 Main St
Brewster, NY 10509-1521
Phone
(845) 279-6999
Fax
(845) 279-0908
NPI assigned
Dec 17, 2012
Organization subpart
Yes
Parent organization
OPEN DOOR FAMILY MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2012

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

Authorized official

Name
Mrs. Maria Mazzotta
Title
Chief Finance Officer
Phone
(914) 502-1470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 5905200R NY Primary

Addresses

Primary practice location

155 Main St
Brewster, NY 10509-1521

Mailing address

165 Main St
Ossining, NY 10562-4702
Phone (914) 502-1470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130606000734 NY Part A Provider - Federally Qualified Health Center (FQHC) 7113835380 Practice locations: Brewster, NY
O20150224001267 NY Part B Supplier - Clinic/Group Practice 7113835380 Receives reassigned benefits from 162 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yonkers, NY; White Plains, NY; Sleepy Hollow, NY; Saugerties, NY; Port Chester, NY; Ossining, NY; Pelham, NY; Brewster, NY…
O20210125002165 NY MDPP Supplier - in-Person MDPP Supplier 7113835380 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brewster, NY; Sleepy Hollow, NY; Port Chester, NY; Ossining, NY; Mount Kisco, NY; Mamaroneck, NY

Federally qualified health center certification: CCN 331063

Legal name
OPEN DOOR FAMILY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 11, 2013
Last certification
Jun 11, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 2, 1975 in NY
Enrollment address
155 Main St
Brewster, NY 10509-1521
Related CCNs
331908

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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
33D2054395Open Door Family Medical Center155 Main Street, Brewster, NY 10509Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Ossining Open Door Heal

Locations

165 Main St
Ste 207
Ossining, NY 10562

300 N Broadway
Sleepy Hollow, NY 10591
Phone (914) 631-4141

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Daysi Briones Individual Corporate DirectorBoard Member May 23, 2018
Dorian Lindsay Individual Corporate DirectorBoard Member Mar 1, 2007
Tyler H Beebe Individual Corporate DirectorBoard Member Dec 1, 2009
David Whitlinger Individual Corporate DirectorBoard Member May 24, 2017
Loretta Molinari Individual Corporate DirectorBoard Member May 22, 2013
Daniel Ross Individual Corporate DirectorBoard Member May 25, 2016
Diana S Schaefer Individual Corporate DirectorBoard Member May 1, 2003
Maria Perez Individual Corporate DirectorBoard Member May 1, 2000
Margoth Pilla Individual Corporate DirectorBoard Member May 1, 2008
Maria Mazzotta Individual Corporate OfficerCfo Feb 22, 2002
W-2 Managing EmployeeCfo Feb 7, 2013
Operational/Managerial ControlCfo Feb 22, 2002
Andres Valdespino Individual Corporate DirectorBoard Member May 1, 2005
Lindsay C Farrell Individual Corporate OfficerPresident/Ceo Oct 1, 1998
W-2 Managing EmployeePresident/Ceo Feb 7, 2013
Operational/Managerial ControlPresident/Ceo Oct 1, 1998
Kevin Nelson Individual Corporate DirectorBoard Member Mar 1, 2004
Shirley Buontempo Individual Corporate DirectorBoard Member Jan 22, 2014
Charles Chehebar Individual Corporate DirectorBoard Member May 1, 1997
Rosa Taylor Individual Corporate DirectorBoard Member Dec 1, 2009
Walter C Edge Individual Corporate DirectorBoard Member May 1, 2001

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 69

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 69

NPI Registry JSON

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

{
    "created_epoch": "1355702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355702400000",
    "number": "1003152240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 MAIN ST",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624702",
            "telephone_number": "914-502-1470",
            "fax_number": "914-762-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 MAIN ST",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105091521",
            "telephone_number": "845-279-6999",
            "fax_number": "845-279-0908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR FAMILY MEDICAL CENTER, INC.",
        "enumeration_date": "2012-12-17",
        "last_updated": "2012-12-17",
        "status": "A",
        "authorized_official_last_name": "MAZZOTTA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CHIEF FINANCE OFFICER",
        "authorized_official_telephone_number": "914-502-1470",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5905200R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewster, NY

Sources for this page

Verify at the official NPI Registry.