NPIMap

Organization Active NPI

Care for the Homeless

Doing business as Susan's Place Health Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1013154657
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7000279R Issued in NY
Legal business name
CARE FOR THE HOMELESS
Doing business as
Susan's Place Health Center
Practice address
1921 Jerome Avenue
Bronx, NY 10453-5707
Phone
(718) 943-1341
Fax
(718) 716-3754
NPI assigned
Jan 20, 2009
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
John Chue, CPA, CGMA
Title
Chief Financial Officer
Phone
(212) 366-4459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7000279R NY Primary

Addresses

Primary practice location

1921 Jerome Avenue
Bronx, NY 10453-5707

Mailing address

30 E 33Rd St
5TH Floor
New York, NY 10016-5337
Phone (212) 366-4459

Other names 1

  • Susan's Place Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090623000531 NY Part A Provider - Federally Qualified Health Center (FQHC) 9830240332 Practice locations: Bronx, NY
O20190129003068 NY Part B Supplier - Clinic/Group Practice 9830240332 Receives reassigned benefits from 28 practitioners
10 other NPIs on this enrollment
Practice locations: Bronx, NY; Brooklyn, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013154657. Details of each certification follow.

Federally qualified health center certification: CCN 331005

Legal name
CARE FOR THE HOMELESS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 13, 2009
Last certification
Aug 13, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1992 in NY
Enrollment address
1911-21 Jerome Avenue
Bronx, NY 10453-5707

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 10

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

National Provider Directory

National Provider Directory
Tax ID family
Care for the Homeless12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

190 Willow Ave
Bronx, NY 10454
Phone (718) 665-9123

1911 Jerome Ave
#21
Bronx, NY 10453

89 Porter Ave
#111
Brooklyn, NY 11237

9023 161st St
Jamaica, NY 11432
Phone (718) 709-5054

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Linda Scott Individual Corporate DirectorBoard Member Jan 1, 1999 5%
Dana E Sherwin Individual Corporate DirectorBoard Member Jan 1, 2003 5%
Derek Vanstraaten Individual Corporate DirectorBoard Member Jan 1, 2003 5%
Regina Olasin Individual Corporate OfficerChief Medical Officer Mar 15, 2016
Operational/Managerial Control Mar 14, 2016
Linda Riefberg Individual Corporate DirectorBoard Member Jan 1, 2008 5%

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1013154657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E 33RD ST",
            "address_2": "5TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165337",
            "telephone_number": "212-366-4459",
            "fax_number": "212-366-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 JEROME AVENUE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104535707",
            "telephone_number": "718-943-1341",
            "fax_number": "718-716-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARE FOR THE HOMELESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-20",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "CHUE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "212-366-4459",
        "authorized_official_credential": "CPA, CGMA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7000279R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susan's Place Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.