Sun River Health Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SUN RIVER HEALTH INC

Practice address

6 Henry St
Hudson River Healthcare, Inc.
Beacon, NY 12508-3058

Phone

(845) 831-0400

Fax

(845) 831-0793

NPI assigned

Dec 19, 2006

Last updated

Mar 11, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

SUN RIVER HEALTHAs reported in NPPES

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

Authorized official

Name

Adam Lipton

Title

VP Info/Practice MGMT Systems

Phone

(914) 384-2375

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083777841. Details of each certification follow.

• CCN 331872 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 331872

Legal name

SUN RIVER HEALTH INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 1, 1992

Last certification

Feb 1, 1992

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 5, 1975 in NY

Enrollment address

6 Henry St
Beacon, NY 12508-3058

Other NPIs on the same Medicare enrollment 1

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

• Sun River Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Peekskill, NY
  • NPI 1619969458

  O20070822000304

  Same enrollment

Part of

Hudson River Healthcare Inc

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FGJEAA

All disclosed owners & managing parties 15

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

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1083777841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5036",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106025036",
            "telephone_number": "914-734-8800",
            "fax_number": "914-734-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 HENRY ST",
            "address_2": "HUDSON RIVER HEALTHCARE, INC.",
            "city": "BEACON",
            "state": "NY",
            "postal_code": "125083058",
            "telephone_number": "845-831-0400",
            "fax_number": "845-831-0793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN RIVER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUN RIVER HEALTH",
        "enumeration_date": "2006-12-19",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "LIPTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "VP INFO/PRACTICE MGMT SYSTEMS",
        "authorized_official_telephone_number": "914-384-2375"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "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": "00473038",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• R. J. Storm, MS, L. AC.
• Maria Streva, LMSW
• Mahnaz Sullivan-Davachi, NP
• Arthur Sullivan, PHD
• Lisa Sullivan
• Paulina Andrea Taylor, FNP
• Tiffany Demichele Teamer, LCSW
• Victor Toujiline
• Nicole Elizabeth Triassi
• Upstate Therapy Group LCSW PLLC

• Federally Qualified Health Center (FQHC) in Beacon, NY
• Providers in Beacon, NY by specialty
• Federally Qualified Health Center (FQHC) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.