NPIMap

Organization Active NPI

The Institute for Family Health

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1053685289
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
THE INSTITUTE FOR FAMILY HEALTH
Practice address
1894 Walton Ave
Bronx, NY 10453-6018
Phone
(718) 583-3060
Fax
(718) 583-3360
NPI assigned
Mar 6, 2012
Last updated
Apr 22, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
THE INSTITUTE FOR FAMILY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Authorized official

Name
Eric Gayle, MD
Title
President and Ceo
Phone
(212) 633-0800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1894 Walton Ave
Bronx, NY 10453-6018

Mailing address

CL # 4655
PO Box 95000
Philadelphia, PA 19195-4655
Phone (845) 255-3435

Other identifiers 1

IdentifierTypeStateIssuer
00903700MedicaidNY

Other names 1

  • Walton Family Practice Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030307000029 NY Part A Provider - Federally Qualified Health Center (FQHC) 9234048588 2 other NPIs on this enrollment
Practice locations: Bronx, NY
O20040417000313 NY Part B Supplier - Clinic/Group Practice 9234048588 Receives reassigned benefits from 337 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New York, NY; Bronx, NY; Brooklyn, NY; Hyde Park, NY; New Paltz, NY; Kingston, NY; Ellenville, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053685289. Details of each certification follow.

Federally qualified health center certification: CCN 331910

Legal name
THE INSTITUTE FOR FAMILY HEALTH
Doing business as
WALTON FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 28, 2003
Last certification
May 28, 2003
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Apr 25, 1985 in NY
Enrollment address
1894 Walton Ave
Bronx, NY 10453-6018

Other NPIs on the same Medicare enrollment 33

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

View all 33

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0947668Walton Family Practice1894 Walton Ave, Bronx, NY 10453Provider-performed microscopyMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Todd Mangum

Locations

1894 Walton Ave
Bronx, NY 10453
Phone (718) 583-2508

6 Healthy Way
Ellenville, NY 12428
Phone (845) 647-4500

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
Leesa Hubbell Individual Corporate DirectorBoard Member Nov 1, 2025
Marsha Rimler Individual Corporate DirectorBoard Member Nov 1, 2025
Caroline Dicioccio Individual Corporate OfficerChief Financial Officer Apr 1, 2019
Kathleen O'Donnell Individual Corporate DirectorBoard Member Aug 1, 2015
Steven Kelley Individual Corporate DirectorBoard Member Mar 19, 2010
Michael Blatchely Individual Corporate DirectorBoard Member Mar 1, 2013
Andrea Zakin-Amano Individual Corporate DirectorBoard Member Mar 1, 2013
Eric Gayle Individual Corporate OfficerPresident & Ceo Apr 1, 2025
W-2 Managing Employee Feb 28, 2024
Tina Goodrich Individual Corporate DirectorBoard Member Mar 9, 2011
Ollie Brown-Carrington Individual Corporate DirectorBoard Member Mar 24, 2003
Samuel Santiago Individual Corporate DirectorBoard Member Apr 6, 2011
Carole Furman Individual Corporate DirectorBoard Member Jan 1, 2007
Josephine Sanchez Individual Corporate DirectorVP of Business Development Feb 20, 2024
W-2 Managing Employee Feb 20, 2024
Maribel Mercado Individual Corporate DirectorBoard Member Nov 1, 2025

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 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1330992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1053685289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CL # 4655",
            "address_2": "PO BOX 95000",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191954655",
            "telephone_number": "845-255-3435",
            "fax_number": "845-256-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1894 WALTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104536018",
            "telephone_number": "718-583-3060",
            "fax_number": "718-583-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE INSTITUTE FOR FAMILY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE INSTITUTE FOR FAMILY HEALTH",
        "enumeration_date": "2012-03-06",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "GAYLE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "212-633-0800",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00903700",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walton Family Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.