NPIMap

Organization Active NPI

Outreach Development Corporation

  • Addiction (Substance Use Disorder) Counselor
  • Richmond Hill, NY
National Provider Identifier
1083717326
Registry record updated Aug 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
070511273 Issued in NY
Legal business name
OUTREACH DEVELOPMENT CORPORATION
Practice address
11711 Myrtle Avenue
Richmond Hill, NY 11418-1751
Phone
(718) 847-9233
Fax
(718) 849-1093
NPI assigned
Sep 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2021

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

Authorized official

Name
Ms. Christine Casiano
Title
Vice President of Operations and Co
Phone
(718) 847-9233

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 081110563 NY
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 061110561 NY
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 070511273 NY Primary

Addresses

Primary practice location

11711 Myrtle Avenue
Richmond Hill, NY 11418-1751

Mailing address

11711 Myrtle Avenue
Richmond Hill, NY 11418
Phone (718) 847-9233

Other identifiers 1

IdentifierTypeStateIssuer
00994803MedicaidNY

Other names 1

  • Outreach Project Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040603001529 NY Part B Supplier - Clinic/Group Practice 1355323270 Receives reassigned benefits from 14 practitioners
Practice locations: Bellport, NY; Brentwood, NY; Brooklyn, NY; Richmond Hill, NY; Roosevelt, NY

National Provider Directory

National Provider Directory
Tax ID family
Outreach Development Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11 Farber Dr
Bellport, NY 11713
Phone (631) 286-0700

998 Crooked Hill Rd
Bldg 5
Brentwood, NY 11717
Phone (631) 521-8400

11711 Myrtle Ave
Richmond Hill, NY 11418
Phone (718) 847-9233

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629072000000",
    "number": "1083717326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 MYRTLE AVENUE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "11418",
            "telephone_number": "718-847-9233",
            "fax_number": "718-849-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11711 MYRTLE AVENUE",
            "city": "RICHMOND HILL",
            "state": "NY",
            "postal_code": "114181751",
            "telephone_number": "718-847-9233",
            "fax_number": "718-849-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTREACH DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "CASIANO",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "VICE PRESIDENT OF OPERATIONS AND CO",
        "authorized_official_telephone_number": "718-847-9233",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "081110563",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "061110561",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "070511273",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00994803",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outreach Project",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Outreach Project",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Richmond Hill, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.