NPIMap

Organization Active NPI

Anthony L. Jordan Health Corporation

Doing business as Brown Square Center

  • Federally Qualified Health Center (FQHC)
  • Rochester, NY
National Provider Identifier
1013291335
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
2701211R Issued in NY
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
Brown Square Center
Practice address
322 Lake Ave
Brown Square Center
Rochester, NY 14608-1162
Phone
(585) 254-6480
Fax
(585) 254-1092
NPI assigned
Oct 5, 2011
Last updated
Feb 4, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTHONY L. JORDAN HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Authorized official

Name
Janice Harbin, DDSNPI 1467533968
Title
President/Ceo
Phone
(585) 423-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 2701211R NY Primary

Addresses

Primary practice location

322 Lake Ave
Brown Square Center
Rochester, NY 14608-1162

Mailing address

82 Holland St
Aljhc
Rochester, NY 14605-2131
Phone (585) 423-5800

Other identifiers 5

IdentifierTypeStateIssuer
16467AOtherNYMEDICARE PART B
331838OtherNYMEDICARE PART A
G0187295590OtherNYBLUE CHOICE OF ROCHESTER
03800906MedicaidNY
6613OtherNYBLUE CROSS OF ROCHESTER

Other names 1

  • Brown Square 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
O20040519001335 NY Part B Supplier - Clinic/Group Practice 8729079785 Receives reassigned benefits from 49 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rochester, NY; Canandaigua, NY
O20111018000444 NY Part A Provider - Federally Qualified Health Center (FQHC) 8729079785 Practice locations: Rochester, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013291335. Details of each certification follow.

Federally qualified health center certification: CCN 331045

Legal name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
BROWN SQUARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 7, 2011
Last certification
Sep 7, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1973 in NY
Enrollment address
322 Lake Ave
Rochester, NY 14608-1162

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 10

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

National Provider Directory

National Provider Directory
Part of
Anthony L Jordan HLTH C

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Mary L Miller Individual Corporate Officer Jul 20, 2005
Bradley M Turner Individual Corporate Director Jan 14, 2017
Shappelle Thompson Individual Corporate Director Nov 18, 2011
Thomas Green Individual Corporate Officer Dec 21, 2015
Clinton Bell Individual Corporate Director Jul 28, 2015
Linda Levita Clark Individual Corporate Officer Jul 27, 2022
Andrew Doniger Individual Corporate Director Sep 27, 2016
Roosevelt Dixon Individual Corporate Director Nov 7, 2023
Lashana Boose Individual Corporate Director Feb 2, 2021
Elias Nieves Individual Corporate Director Feb 1, 2022
Carlett McMillan Individual W-2 Managing EmployeeSenior Human Resources Generalist Jul 24, 2017
Sammy Ndive Individual Corporate Director Jan 29, 2010
Van Smith Individual Corporate Director Jun 13, 2023
Walida Monroe-Sims Individual Corporate Director Dec 5, 2023
Derrill Blue Individual Corporate Director Jan 9, 2024
Jonathan Clune Individual Corporate OfficerCfo Nov 11, 2004
W-2 Managing Employee Nov 11, 2004

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anthony L. Jordan Health CorporationRochester, NY, CCN 331027 Federally qualified health center Operational/Managerial Control Nov 1, 2010
Woodward CenterRochester, NY, CCN 331044 Federally qualified health center Operational/Managerial Control Aug 27, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1013291335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 HOLLAND ST",
            "address_2": "ALJHC",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-423-5800",
            "fax_number": "585-423-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 LAKE AVE",
            "address_2": "BROWN SQUARE CENTER",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146081162",
            "telephone_number": "585-254-6480",
            "fax_number": "585-254-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "enumeration_date": "2011-10-05",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "HARBIN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "585-423-5800",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "2701211R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "16467A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "331838",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE OF ROCHESTER",
            "identifier": "G0187295590",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03800906",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ROCHESTER",
            "identifier": "6613",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brown Square Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.