NPIMap

Organization Active NPI

Family Health Network of Central New York, Inc

  • Federally Qualified Health Center (FQHC)
  • Marathon, NY
National Provider Identifier
1114158276
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC
Practice address
20 East Main Street
Marathon, NY 13803-0448
Phone
(607) 849-3271
Fax
(607) 849-6357
NPI assigned
Aug 6, 2009
Organization subpart
Yes
Parent organization
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Authorized official

Name
Kimberly Osborne
Title
Ceo
Phone
(607) 753-3797

Specialties & licenses 1

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

Addresses

Primary practice location

20 East Main Street
Marathon, NY 13803-0448

Mailing address

85 South West Street
Homer, NY 13077-0000
Phone (607) 753-3797

Other identifiers 1

IdentifierTypeStateIssuer
331862OtherNYMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140106001494 NY Part A Provider - Federally Qualified Health Center (FQHC) 2668385014 Practice locations: Marathon, NY

Federally qualified health center certification: CCN 331862

Legal name
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Doing business as
RURAL HEALTH SERVICES DEVELOPMENT ASSOCIATION
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 – partnership
Organization structure
CorporationNon-profit
Incorporated
May 2, 1989 in NY
Enrollment address
20 East Main Street
Marathon, NY 13803-0399

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Netwk of8 organizations share this tax ID, including this one
Part of
Family Health Netwk of

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kimberly Osborne Individual Corporate OfficerPresident/Ceo Sep 21, 2019 100%
W-2 Managing EmployeePresident/Ceo Sep 21, 2019
John Robert Hughes Individual Corporate DirectorBoard President Sep 18, 2019
Diane Wheaton Individual Corporate DirectorBoard Member Feb 23, 2011
Tara Larrabee Individual Corporate DirectorBoard Member Oct 31, 2018
Charles Sherman Individual Corporate DirectorBoard Treasurer Jun 12, 2019
Elaine Lambert Individual Corporate DirectorBoard Member Aug 10, 2022
Greg Richards Individual Corporate DirectorBoard Member Jun 28, 2017
Shirley Garcia Individual Corporate DirectorBoard Member Jun 28, 2017
Thomas Tylutki Individual Corporate DirectorBoard Member Mar 11, 2020
Kimberly Sharpe Individual Corporate DirectorBoard Member Jun 14, 2023
Jeanette Dippo Individual Corporate DirectorBoard Secretary Feb 22, 2006

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641772800000",
    "number": "1114158276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 SOUTH WEST STREET",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130770000",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 EAST MAIN STREET",
            "city": "MARATHON",
            "state": "NY",
            "postal_code": "138030448",
            "telephone_number": "607-849-3271",
            "fax_number": "607-849-6357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC",
        "enumeration_date": "2009-08-06",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "607-753-3797"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "331862",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marathon, NY

Sources for this page

Verify at the official NPI Registry.