NPIMap

Organization Active NPI

Bedford Stuyvesant Family Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
National Provider Identifier
1033178561
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEDFORD STUYVESANT FAMILY HEALTH CENTER, INC.
Practice address
1456 Fulton St
Brooklyn, NY 11216-2505
Phone
(718) 636-4500
Fax
(347) 296-8308
NPI assigned
Mar 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Nurah Jahan Abdur-Rahman
Title
Credentialing Coordinator
Phone
(718) 636-4500

Specialties & licenses 1

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

Addresses

Primary practice location

1456 Fulton St
Brooklyn, NY 11216-2505

Mailing address

1456 Fulton St
Brooklyn, NY 11216-2505
Phone (718) 636-4500

Other identifiers 1

IdentifierTypeStateIssuer
00730483MedicaidNY

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100322000535 NY Part A Provider - Federally Qualified Health Center (FQHC) 0143361238 Practice locations: Brooklyn, NY
O20160711000489 NY Part A Provider - Federally Qualified Health Center (FQHC) 0143361238 Practice locations: Brooklyn, NY
O20180423001743 NY Part B Supplier - Clinic/Group Practice 0143361238 Receives reassigned benefits from 52 practitioners
1 other NPI on this enrollment
Practice locations: Brooklyn, NY

Federally qualified health center certification: CCN 331840

Legal name
BEDFORD STUYVESANT FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 30, 1992
Last certification
Sep 30, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 1976 in NY
Enrollment address
1456 Fulton St
Brooklyn, NY 11216-2505

Federally qualified health center certification: CCN 571053

Legal name
BEDFORD STUYVESANT FAMILY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2017
Last certification
Jan 9, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 1976 in NY
Enrollment address
1238 Broadway
Brooklyn, NY 11221-2906

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

300 Willoughby Ave
Brooklyn, NY 11205
Phone (718) 230-4087

195 Sandford St
Brooklyn, NY 11205
Phone (718) 237-2255

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DFDFAA

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Bedford Stuyvesant Family Health Center Inc Organization, Brooklyn, NY Non-profit Operational/Managerial Control Sep 30, 1992
Nigel Fernandez Individual Corporate DirectorPresident/Ceo Jun 1, 2023
W-2 Managing EmployeePresident/Ceo Jun 1, 2023
Corporate OfficerCeo Jun 10, 2023
W-2 Managing EmployeeCeo Jun 10, 2023
Operational/Managerial ControlCeo Jun 10, 2023
Honglam Theresa Nguyen Individual Corporate DirectorCredentialing Director Jun 1, 2023
W-2 Managing EmployeeCredentialing Director Jun 1, 2023
Michael a Joseph Individual Other Apr 1, 2017
Corporate DirectorBoard Member Apr 1, 2017
Robin Sheares Individual Other May 1, 2014
Corporate DirectorBoard Member May 1, 2014
Clarence Stewart Individual Other Mar 1, 1995
Corporate DirectorBoard Member Mar 1, 1995
Eulene Inniss Individual OtherBoard Member Jan 1, 2014
Corporate DirectorBoard Member Jan 1, 2014
Marlienne Christian Individual Other Jan 1, 2020
Corporate DirectorBoard Member Jan 1, 2020
Edna Fulton Individual Other Feb 1, 2014
Corporate DirectorBoard Member Feb 1, 2014

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 55

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

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1033178561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1456 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162505",
            "telephone_number": "718-636-4500",
            "fax_number": "347-296-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1456 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162505",
            "telephone_number": "718-636-4500",
            "fax_number": "347-296-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEDFORD STUYVESANT FAMILY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "ABDUR-RAHMAN",
        "authorized_official_first_name": "NURAH JAHAN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "718-636-4500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00730483",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.