Family Health Network of Central New York, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Homer, NY
NPI 1043374853 · NPPES record last updated Oct 9, 2023
Key facts
- NPI
- 1043374853
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
- Practice address
- 85 South West Street
Homer, NY 13077-0000 - Phone
- (607) 753-3797
- Fax
- (607) 753-6677
- NPI assigned
- Dec 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Osborne
- Title
- Ceo
- Phone
- (607) 753-3797
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 6
Subparts reporting this organization as parent 11
Practitioners 48
-
Maya Aponte, M.D
-
Samantha Dinse, NP
-
Teresa L Dodge, NP
-
Kelly J Hirsch, FNP
-
Susan E Jewett, PA
-
Daniel F Karn, PA
-
Kelly Elizabeth Noble, M.D.
-
Yvonne Marie Starner, LCSW
-
Carolyne Yonta, PA
-
Nancy A. Dickerson, LCSW
-
Maximo Jose D'Oleo, M.D.
-
Ashley Yonsook Ki, D.D.S.
-
Virginia Bersani, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Federally qualified health center certification: CCN 331837
- Legal name
- FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
- Doing business as
- CINCINNATUS RURAL HEALTH CENTER CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 1, 1993
- Last certification
- Jan 1, 1993
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 2, 1989 in NY
- Enrollment address
- 2805 Cincinnatus Rd
Cincinnatus, NY 13040-9685
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Osborne |
Corporate Officer |
Sep 21, 2019 | 100% |
| W-2 Managing Employee |
Sep 21, 2019 | ||
| John Robert Hughes |
Corporate Director |
Sep 18, 2019 | |
| Diane Wheaton |
Corporate Director |
Feb 23, 2012 | |
| Tara Larrabee |
Corporate Director |
Oct 31, 2018 | |
| Charles Sherman |
Corporate Officer |
Jun 12, 2019 | |
| Elaine Lambert |
Corporate Director |
Aug 10, 2022 | |
| Greg Richards |
Corporate Director |
Jun 28, 2017 | |
| Shirley Garcia |
Corporate Director |
Jun 28, 2017 | |
| Thomas Tylutki |
Corporate Director |
Mar 11, 2020 | |
| Kimberly Sharpe |
Corporate Director |
Jun 14, 2023 | |
| Jeanette Dippo |
Corporate Director |
Jun 28, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000423 | NY | Part B Supplier - Clinic/Group Practice | 2668385014 |
Receives reassigned benefits from 25 practitioners Practice locations: Cincinnatus, NY; Moravia, NY; Marathon, NY; Homer, NY; De Ruyter, NY; Cortland, NY |
| O20100908001134 | NY | Part a Provider - Federally Qualified Health Center (FQHC) | 2668385014 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cincinnatus, NY |
National Provider Directory
Locations
2809 Cincinnatus Rd
Cincinnatus, NY 13040
Phone (607) 863-3200
4038 West Rd
Cortland, NY 13045
Phone (607) 758-3008
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | NY | ||
| Family Medicine Physician |
207Q00000X | NY | ||
| Gynecology Physician |
207VG0400X | |||
| Pediatrics Physician |
208000000X | NY | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Physician Assistant |
363A00000X | NY | ||
| Nurse Practitioner |
363L00000X | NY |
Addresses
Primary practice location
85 South West Street
Homer, NY 13077-0000
Mailing address
85 S West St
Homer, NY 13077-1542
Phone (607) 753-3797
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00474144 | Medicaid | NY |
Other providers in Homer, NY
- Department of Medicine Medical Service Group
- Jamie Lynn Driscoll
- Heidi Jean Effinger
- Elizabeth Brewster House
- Cinthia Lisa Elkins
- Family Health Network of Central New York, Inc.
- Family Health Network of Central New York, Inc.
- Theresa Ferris
- David Brian Finn
- Elaine Elizabeth Fisher
All providers in Homer, NY · Federally Qualified Health Center (FQHC) in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.