NPIMap

Organization Active NPI

Family Health Network of Central New York, Inc.

  • Federally Qualified Health Center (FQHC)
  • Homer, NY
National Provider Identifier
1043374853
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Kimberly Osborne
Title
Ceo
Phone
(607) 753-3797

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician Assistant 363A00000X NY
Nurse Practitioner 363L00000X NY
General Practice Dentistry 1223G0001X NY
Family Medicine Physician 207Q00000X NY
Gynecology Physician 207VG0400X
Pediatrics Physician 208000000X 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 1

IdentifierTypeStateIssuer
00474144MedicaidNY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043374853. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 2, 1989 in NY
Enrollment address
2805 Cincinnatus Rd
Cincinnatus, NY 13040-9685

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 1

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

National Provider Directory

National Provider Directory

Locations

4038 West Rd
Cortland, NY 13045
Phone (607) 758-3008

711 Railroad St
De Ruyter, NY 13052
Phone (315) 852-3400

3 Technology Pl
Homer, NY 13077
Phone (607) 753-3774

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kimberly Osborne Individual Corporate OfficerPresident/Ceo Sep 21, 2019 100%
W-2 Managing EmployeeCeo Sep 21, 2019
John Robert Hughes Individual Corporate DirectorBoard President Sep 18, 2019
Diane Wheaton Individual Corporate DirectorBoard Member Feb 23, 2012
Tara Larrabee Individual Corporate DirectorBoard Member Oct 31, 2018
Charles Sherman Individual Corporate OfficerBoard Treasurer Jun 12, 2019
Elaine Lambert Individual Corporate DirectorBoard Member Aug 10, 2022
Greg Richards Individual Corporate DirectorBoard Member Jun 28, 2017
Shirley Garcia Individual Corporate DirectorBoard Member Jun 28, 2017
Thomas Tylutki Individual Corporate DirectorBoard Member Mar 11, 2020
Kimberly Sharpe Individual Corporate DirectorBoard Member Jun 14, 2023
Jeanette Dippo Individual Corporate DirectorBoard Secretary Jun 28, 2017

Subparts reporting this organization as parent 11

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1043374853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S WEST ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771542",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SOUTH WEST STREET",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130770000",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "607-753-3797"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00474144",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Homer, NY

Sources for this page

Verify at the official NPI Registry.