NPIMap

Organization Active NPI

Damian Family Care Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1104908557
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DAMIAN FAMILY CARE CENTERS, INC.
Practice address
1600 Macombs Road
Bronx, NY 10452
Phone
(718) 466-8800
Fax
(718) 466-8870
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
John Chue, CPA
Title
Chief Financial Officer
Phone
(718) 657-1100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NY
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1600 Macombs Road
Bronx, NY 10452

Mailing address

138-02 Queens Blvd, 2ND Floor
Briarwood, NY 11435
Phone (718) 657-1100

Other identifiers 1

IdentifierTypeStateIssuer
01690633MedicaidNY

Other names 1

  • Project Samaritan Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130517000469 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507849882 Practice locations: Bronx, NY

Federally qualified health center certification: CCN 331939

Legal name
DAMIAN FAMILY CARE CENTERS, INC.
Doing business as
STARHILL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 19, 2004
Last certification
Jul 19, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 29, 1996 in NY
Enrollment address
1600 Macombs Rd
Bronx, NY 10452-2016

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Damian Family Care Ctr11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1600 Macombs Rd
Bronx, NY 10452
Phone (718) 299-3300

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
John Tavolacci Individual Corporate DirectorBoard Member Jun 21, 2016
Peter Grisafi Individual Corporate OfficerPresident / Ceo Oct 1, 2013
Corporate DirectorBoard Member Feb 29, 1996
W-2 Managing EmployeePresident/ Ceo Oct 1, 2013
Junnie E Campbell Individual Corporate OfficerSecretary Jul 1, 2003
Corporate DirectorSecretary Jul 1, 2003
Operational/Managerial Control Jul 1, 2003
Arismendi Jimenez Individual Corporate DirectorBoard Member Mar 21, 2017
Michael Degraffenreid Individual Corporate DirectorBoard Member Jul 1, 2011
Cynthia Cortes Individual Corporate DirectorBoard Member Jun 15, 2004
Janet Moss Individual Corporate DirectorBoard Member Jul 1, 2003
Idania Lopez Mercado Individual Corporate DirectorBoard Member Aug 16, 2016
Evdoxia Pittas Individual Corporate DirectorBoard Treasurer Mar 21, 2017
Stephanie James Individual Corporate DirectorBoard Member Jul 1, 2003
Gordon Siess Individual Corporate OfficerChief Financial Officer Oct 8, 2020
Jane Velez Individual Corporate OfficerBoard Vice Chairperson Feb 29, 1996
Corporate DirectorBoard Vice Chairperson Feb 29, 1996
Operational/Managerial Control Feb 29, 1996
Chinyere Eze-Nliam Individual Corporate DirectorBoard Member Mar 29, 2016

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1104908557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138-02 QUEENS BLVD, 2ND FLOOR",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "11435",
            "telephone_number": "718-657-1100",
            "fax_number": "718-657-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 MACOMBS ROAD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10452",
            "telephone_number": "718-466-8800",
            "fax_number": "718-466-8870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMIAN FAMILY CARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "CHUE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "718-657-1100",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "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": "01690633",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Project Samaritan Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Project Samaritan Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.