NPIMap

Organization Active NPI

William F Ryan Community Health Center Inc

Doing business as Ryan Frederick Douglass Community Health Center

  • Federally Qualified Health Center (FQHC)
  • New York, NY
National Provider Identifier
1013360528
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7002243R Issued in NY
Legal business name
WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Doing business as
Ryan Frederick Douglass Community Health Center
Practice address
2381 Frederick Douglass Blvd
New York, NY 10027-1822
Phone
(212) 749-1820
NPI assigned
Jul 20, 2016
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAM F RYAN COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Mr. Jose Virella
Title
Chief Financial Officer
Phone
(212) 316-7906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7002243R NY Primary

Addresses

Primary practice location

2381 Frederick Douglass Blvd
New York, NY 10027-1822

Mailing address

2381 Frederick Douglass Blvd
New York, NY 10027-1822

Other identifiers 1

IdentifierTypeStateIssuer
04633116MedicaidNY

Other names 1

  • Ryan Frederick Douglass Community 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
O20041023000026 NY Part B Supplier - Clinic/Group Practice 4880596550 Receives reassigned benefits from 203 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New York, NY
O20161116001022 NY Part A Provider - Federally Qualified Health Center (FQHC) 4880596550 Practice locations: New York, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013360528. Details of each certification follow.

Federally qualified health center certification: CCN 571050

Legal name
WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Doing business as
RYAN HEALTH|FREDERICK DOUGLASS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 25, 2016
Last certification
Nov 25, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1977 in NY
Enrollment address
2381 Frederick Douglass Blvd
New York, NY 10027-1822

Other NPIs with the same Medicare PAC ID 7

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.

National Provider Directory

National Provider Directory
Tax ID family
William F Ryan Community He12 organizations share this tax ID, including this one
Part of
William F Ryan Community He

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Valeria Spann Individual Corporate DirectorBoard Member Jun 2, 2008
Harriet King Individual Corporate DirectorBoard Vice President Jun 2, 2008
Anyanate G Jack Individual Corporate DirectorBoard Member Jul 1, 2019
Philip Chen Individual Corporate DirectorBoard Member Jul 31, 2015
Margaret Gramins Individual Corporate DirectorBoard Member Jun 5, 2017
Lois Dorman Individual Corporate DirectorBoard Member Jul 1, 2019
Brian McIndoe Individual Corporate OfficerPresident and Ceo Jun 14, 2016
Hope Mason Individual Corporate DirectorBoard Member Jun 2, 2008
Atif Abdul Haqq Individual Corporate DirectorBoard Member Jun 2, 2008
Juli a Harkins Individual Corporate DirectorBoard Member Jul 1, 2016
Ronald Guy Individual Corporate DirectorBoard President Jun 2, 2008
Joseph Haslip Individual Corporate DirectorBoard Member Jun 2, 2008
Ronnie Lowenstein Individual Corporate DirectorBoard Member Nov 6, 2017
Charles Shorter Individual W-2 Managing EmployeeExecutive Director Jun 14, 2016

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 6

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": "1468972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1013360528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2381 FREDERICK DOUGLASS BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100271822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2381 FREDERICK DOUGLASS BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100271822",
            "telephone_number": "212-749-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM F RYAN COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM F RYAN COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2016-07-20",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "VIRELLA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "212-316-7906",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7002243R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04633116",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ryan Frederick Douglass Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ryan Frederick Douglass Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.