NPIMap

Organization Active NPI

Anthony L. Jordan Health Corporation

  • Federally Qualified Health Center (FQHC)
  • Rochester, NY
National Provider Identifier
1083716088
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
2701211R Issued in NY
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Practice address
82 Holland Street
Rochester, NY 14605-2131
Phone
(585) 423-5800
Fax
(585) 423-2890
NPI assigned
Sep 1, 2006
Last updated
Feb 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Authorized official

Name
Monica Graham
Title
HR Credentilaing Specialist
Phone
(585) 423-2816

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NY
Federally Qualified Health Center (FQHC) 261QF0400X 2701211R NY Primary

Addresses

Primary practice location

82 Holland Street
Rochester, NY 14605-2131

Mailing address

82 Holland Street
C/O HR Credenting Dept.
Rochester, NY 14605-2131
Phone (585) 423-2816

Other identifiers 5

IdentifierTypeStateIssuer
G0187295590OtherNYBLUE CHOICE OF ROCHESTER
331838OtherNYMEDICARE PART A
16467AOtherNYMEDICARE PART B
6613OtherNYBLUE CROSS OF ROCHESTER
00384969MedicaidNY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040519001335 NY Part B Supplier - Clinic/Group Practice 8729079785 Receives reassigned benefits from 49 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rochester, NY; Canandaigua, NY
O20100324000655 NY Part A Provider - Federally Qualified Health Center (FQHC) 8729079785 Practice locations: Rochester, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083716088. Details of each certification follow.

Federally qualified health center certification: CCN 331838

Legal name
ANTHONY L. JORDAN HEALTH CORPORATION
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 – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1973 in NY
Enrollment address
82 Holland St
Rochester, NY 14605-2131

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 10

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 14

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

NameRoleSinceShare
Delois Crawford Individual Corporate DirectorFoundation Board Chair Jun 1, 2019
Bradley M Turner Individual Corporate Director Jun 1, 2019
Michele Boyd Individual Corporate Director Jun 1, 2019
Linda Covington Individual Corporate Director Jun 1, 2019
Diana Aguirre Individual W-2 Managing Employee Jan 11, 2024
Shappelle Thompson Individual Corporate DirectorBoard Member Nov 18, 2010
S. Dolly Malik Individual Corporate DirectorBoard Member Nov 26, 2013
Clinton Bell Individual Corporate OfficerVice Chairperson Jun 1, 2019
Andrew Doniger Individual Corporate Director Jun 1, 2019
Jason Dunn Individual Corporate Officer Sep 1, 2024
Carlett McMillan Individual W-2 Managing Employee Jul 24, 2017
Sammy Ndive Individual Corporate DirectorBoard Member Jan 29, 2010
Mohamed Gazali Individual Corporate Director Jun 1, 2019
Isse Abukar Individual Corporate DirectorBoard Member May 31, 2012

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Anthony L. Jordan Health CorporationRochester, NY, CCN 331027 Federally qualified health center Operational/Managerial Control Nov 1, 2010
Woodward CenterRochester, NY, CCN 331044 Federally qualified health center Operational/Managerial Control Aug 27, 2011

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1083716088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 HOLLAND STREET",
            "address_2": "C/O HR CREDENTING DEPT.",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-423-2816",
            "fax_number": "585-423-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 HOLLAND STREET",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-423-5800",
            "fax_number": "585-423-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "HR CREDENTILAING SPECIALIST",
        "authorized_official_telephone_number": "585-423-2816"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "2701211R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE OF ROCHESTER",
            "identifier": "G0187295590",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "331838",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "16467A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ROCHESTER",
            "identifier": "6613",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00384969",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.