NPIMap

Organization Active NPI

Advantage Care Diagnostic and Treatment Center ,Inc

  • Federally Qualified Health Center (FQHC)
  • Brookville, NY
National Provider Identifier
1073689600
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER ,INC
Practice address
189 Wheatley Rd
Brookville, NY 11545
Phone
(516) 626-1075
Fax
(516) 396-9766
NPI assigned
Nov 27, 2006
Last updated
Aug 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

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

Authorized official

Name
Mrs. Rachele D Moise
Title
Clinic Billing Manager
Phone
(516) 626-1075

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

189 Wheatley Rd
Brookville, NY 11545

Mailing address

189 Wheatley Rd
Brookville, NY 11545-2641
Phone (516) 626-1075

Other identifiers 1

IdentifierTypeStateIssuer
02661801MedicaidNY

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050505000457 NY Part B Supplier - Clinic/Group Practice 6800836255 Receives reassigned benefits from 36 practitioners
Practice locations: Glen Head, NY; Freeport, NY
O20150807014991 NY Part A Provider - Federally Qualified Health Center (FQHC) 6800836255 Practice locations: Brookville, NY
O20150817000555 NY Part A Provider - Federally Qualified Health Center (FQHC) 6800836255 Practice locations: Freeport, NY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1073689600. Details of each certification follow.

Federally qualified health center certification: CCN 331163

Legal name
ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER INC
Doing business as
ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER, INC.
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 2015 in NY
Enrollment address
189 Wheatley Rd
Brookville, NY 11545-2641

Federally qualified health center certification: CCN 331156

Legal name
ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER INC
Doing business as
ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 24, 2015
Last certification
Aug 24, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 2015 in NY
Enrollment address
230 Hanse Ave
Freeport, NY 11520-4648

National Provider Directory

National Provider Directory

Locations

230 Hanse Ave
Freeport, NY 11520
Phone (516) 686-4400

189 Wheatley Rd
Glen Head, NY 11545
Phone (516) 626-1075

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Robert Steinberger Individual Corporate OfficerVice President Nov 1, 2013 100%
Thomas L Williams Individual Corporate DirectorBoard Member Jun 1, 2015 100%
Corporate OfficerBoard Member Jun 1, 2015 100%
Thomas F Moore Individual Corporate OfficerTreasurer Nov 1, 2013 100%
Mary Ellen Diver Individual Corporate OfficerCeo Jul 7, 2015 100%
W-2 Managing EmployeeChief Executive Officer Jul 7, 2015 100%
W-2 Managing EmployeeCeo Jul 7, 2015 100%
Jack Garofalo Individual Corporate OfficerSecretary Nov 1, 2013 100%
Frederick Sterbenz Individual Corporate OfficerBoard Member Nov 1, 2013 100%
Frederic Kunken Individual Corporate OfficerBoard Member Nov 1, 2013 100%
Bernard Rosof Individual Corporate OfficerBoard Member Nov 1, 2013 100%

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534809600000",
    "number": "1073689600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 WHEATLEY RD",
            "city": "BROOKVILLE",
            "state": "NY",
            "postal_code": "115452641",
            "telephone_number": "516-626-1075",
            "fax_number": "516-396-9766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 WHEATLEY RD",
            "city": "BROOKVILLE",
            "state": "NY",
            "postal_code": "11545",
            "telephone_number": "516-626-1075",
            "fax_number": "516-396-9766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE CARE DIAGNOSTIC AND TREATMENT CENTER ,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2018-08-21",
        "status": "A",
        "authorized_official_last_name": "MOISE",
        "authorized_official_first_name": "RACHELE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CLINIC BILLING MANAGER",
        "authorized_official_telephone_number": "516-626-1075",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "02661801",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookville, NY

Sources for this page

Verify at the official NPI Registry.