NPIMap

Organization Active NPI

Morris Heights Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1104374685
Registry record updated Apr 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7000236R Issued in NY
Legal business name
MORRIS HEIGHTS HEALTH CENTER, INC.
Practice address
825 E 233Rd St
Bronx, NY 10466-3203
Phone
(718) 716-4400
NPI assigned
Sep 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2018

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

Authorized official

Name
Pamella Appia
Title
Manager, Provider Enrollment & Mana
Phone
(718) 483-1270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7000236R NY Primary

Addresses

Primary practice location

825 E 233Rd St
Bronx, NY 10466-3203

Mailing address

85 W Burnside Ave
Bronx, NY 10453-4015
Phone (718) 483-1270

Other identifiers 1

IdentifierTypeStateIssuer
00590390MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191227000377 NY Part A Provider - Federally Qualified Health Center (FQHC) 3072798172 Practice locations: Bronx, NY

Federally qualified health center certification: CCN 571191

Legal name
MORRIS HEIGHTS HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 12, 2019
Last certification
Dec 12, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 17, 1984 in NY
Enrollment address
825 E 233Rd St
Bronx, NY 10466-3203

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Locations

25 E 183rd St
Bronx, NY 10453
Phone (718) 483-1270

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Laura Keppis Individual Corporate DirectorBoard Member May 23, 2019
Mari G Millet Individual Corporate OfficerPresident and Ceo Oct 1, 2017 100%
Operational/Managerial ControlPresident and Ceo Oct 1, 2017 100%
Gideon Dunkley Individual Corporate DirectorBoard Member May 24, 2007
Daniel Thwaites Individual Corporate DirectorBoard Member Jan 25, 2018
Jose Serrano Individual Corporate DirectorBoard Member Oct 27, 1988
Mireille Bastien Individual Corporate DirectorBoard Member May 23, 2019
Robert Mercedes Individual Corporate DirectorBoard Member Sep 27, 2012
Manuel Martinez Individual Corporate DirectorBoard Member May 23, 2019
Thomas Isekenegbe Individual Corporate DirectorBoard Member Oct 27, 2016
Virginia Pou Individual Corporate DirectorBoard Member Sep 28, 2017
Prospere Remy Individual Corporate DirectorBoard Member Mar 25, 2004
Janet Stieg Individual Corporate DirectorBoard Member Oct 27, 2016
Diane L. Womack Individual Corporate DirectorBoard Member Nov 2, 2017
Edmund Milford Individual Corporate DirectorBoard Member Dec 10, 2015
Arsenia Golfo Individual Corporate DirectorBoard Member Sep 28, 2017
Paulette R Bainbridge Individual Corporate DirectorBoard Chairperson Feb 28, 2005

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 98

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

View all 98

NPI Registry JSON

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

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523491200000",
    "number": "1104374685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 W BURNSIDE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534015",
            "telephone_number": "718-483-1270",
            "fax_number": "718-228-7471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 E 233RD ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104663203",
            "telephone_number": "718-716-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORRIS HEIGHTS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-14",
        "last_updated": "2018-04-12",
        "status": "A",
        "authorized_official_last_name": "APPIA",
        "authorized_official_first_name": "PAMELLA",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT & MANA",
        "authorized_official_telephone_number": "718-483-1270"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7000236R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00590390",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.