NPIMap

Organization Active NPI

Risewell Community Services

  • Community/Behavioral Health Agency
  • Patchogue, NY
National Provider Identifier
1073706032
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
03007701 Issued in NY
Legal business name
RISEWELL COMMUNITY SERVICES
Practice address
456 Waverly Ave
Patchogue, NY 11772-1586
Phone
(631) 447-6460
Fax
(631) 289-7098
NPI assigned
Aug 23, 2007
Last updated
Aug 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
Stephen McCarthy, CFO
Title
Chief Financial Officer
Phone
(631) 669-5355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 03007701 NY Primary

Addresses

Primary practice location

456 Waverly Ave
Patchogue, NY 11772-1586

Mailing address

1 Farmingdale
Route 109
West Babylon, NY 11704-6545
Phone (631) 669-5355

Other identifiers 1

IdentifierTypeStateIssuer
03007701MedicaidNY

Other names 1

  • Federation of Organizations for th NYS Mentally Disabled Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050721001040 NY Part B Supplier - Clinic/Group Practice 6800823782 Receives reassigned benefits from 25 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wyandanch, NY; West Babylon, NY; Patchogue, NY; Copiague, NY; Brooklyn, NY

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

456 Waverly Ave
Patchogue, NY 11772
Phone (631) 447-6460

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1073706032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FARMINGDALE",
            "address_2": "ROUTE 109",
            "city": "WEST BABYLON",
            "state": "NY",
            "postal_code": "117046545",
            "telephone_number": "631-669-5355",
            "fax_number": "631-669-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "456 WAVERLY AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721586",
            "telephone_number": "631-447-6460",
            "fax_number": "631-289-7098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISEWELL COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "631-669-5355",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "03007701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03007701",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Federation of Organizations for th NYS Mentally Disabled",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Patchogue, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.