NPIMap

Organization Active NPI

Oak Orchard Community Health Center, Inc.

Doing business as Oak Orchard Health Medina

  • Federally Qualified Health Center (FQHC)
  • Medina, NY
National Provider Identifier
1083357719
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Doing business as
Oak Orchard Health Medina
Practice address
911 W Center St
Medina, NY 14103-1039
Phone
(585) 765-2060
Fax
(585) 765-2067
NPI assigned
Apr 20, 2022
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Joni Bauersmith
Title
Accountant
Phone
(585) 637-3905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

911 W Center St
Medina, NY 14103-1039

Mailing address

300 West Ave
Brockport, NY 14420-1118
Phone (585) 637-3905

Other names 1

  • Oak Orchard Health Medina Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040521001124 NY Part B Supplier - Clinic/Group Practice 5496746927 Receives reassigned benefits from 61 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hornell, NY; Warsaw, NY; Medina, NY; Lyndonville, NY; Corfu, NY; Batavia, NY; Albion, NY; Alexander, NY…
O20220722002592 NY Part A Provider - Federally Qualified Health Center (FQHC) 5496746927 Practice locations: Medina, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083357719. Details of each certification follow.

Federally qualified health center certification: CCN 571834

Legal name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Doing business as
OAK ORCHARD HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 26, 2022
Last certification
Jul 26, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 21, 1973 in NY
Enrollment address
911 W Center St
Medina, NY 14103-1039

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Elly Jones Individual W-2 Managing EmployeeFinance Manager Apr 1, 2022
Sarah Sargent Individual Corporate OfficerCfo Nov 15, 2015
W-2 Managing EmployeeController Nov 15, 2015
John Slenker Individual Corporate DirectorBoard Chair Aug 27, 2026
Casandra Villanueva Individual Corporate Officer Aug 27, 2024
Meredith Field Individual Corporate DirectorBoard Member Aug 26, 2022
Marco Altieri Individual Corporate Officer Jan 5, 2026
Anthony Dibenedetto Individual Corporate DirectorBoard Treasurer Feb 28, 2024
Cynda Watroba Individual Corporate DirectorBod Jan 19, 2022
Joni Bauersmith Individual W-2 Managing EmployeeAccountant Jun 11, 2013

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Oak Orchard Community Health Center, Inc.Albion, NY, CCN 571832 Federally qualified health center Operational/Managerial Control Mar 9, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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": "1650412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1083357719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201118",
            "telephone_number": "585-637-3905",
            "fax_number": "585-637-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 W CENTER ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "141031039",
            "telephone_number": "585-765-2060",
            "fax_number": "585-765-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK ORCHARD COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-20",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "BAUERSMITH",
        "authorized_official_first_name": "JONI",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "585-637-3905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Orchard Health Medina",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medina, NY

Sources for this page

Verify at the official NPI Registry.