NPIMap

Organization Active NPI

Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Newburgh, NY
National Provider Identifier
1114757515
Registry record updated Aug 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CORNERSTONE FAMILY HEALTHCARE
Practice address
100 Broadway
Newburgh, NY 12550-5514
Phone
(845) 569-8412
NPI assigned
Aug 2, 2024
Last updated
Aug 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
CORNERSTONE FAMILY HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 2, 2024

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

Authorized official

Name
David Jolly
Title
Ceo
Phone
(845) 220-3165

Specialties & licenses 1

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

Addresses

Primary practice location

100 Broadway
Newburgh, NY 12550-5514

Mailing address

2570 Route 9W Ste 10
Cornwall, NY 12518-1370
Phone (845) 220-3100

Other names 1

  • The Greater Hudson Valley Family Health Center, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110913000066 NY Part A Provider - Federally Qualified Health Center (FQHC) 4880610393 1 other NPI on this enrollment
Practice locations: Newburgh, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114757515. Details of each certification follow.

Federally qualified health center certification: CCN 331032

Legal name
CORNERSTONE FAMILY HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 26, 2011
Last certification
Oct 26, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1981 in NY
Enrollment address
100 Broadway
Newburgh, NY 12550-5514
Related CCNs
331832

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ahmad Masood11 organizations share this tax ID, including this one
Part of
Ahmad Masood

Other organizations with this tax ID 10

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

Locations

14 Grove St
Middletown, NY 10940
Phone (845) 342-6601

100 Broadway
Newburgh, NY 12550
Phone (845) 569-8412

290 Broadway
Newburgh, NY 12550
Phone (845) 561-3759

290 Broadway
Ste 23
Newburgh, NY 12550
Phone (845) 561-3759

3 Washington Ctr
Newburgh, NY 12550
Phone (845) 565-3138

Interoperability endpoints

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Gopal Bhalla Individual Corporate OfficerBoard Member Aug 22, 2023
Michele McKeon Individual Corporate OfficerBoard Member Apr 26, 2022
Nelson McAllister Individual Corporate OfficerBoard Member Jan 1, 2002
Andrew Bell Individual Corporate OfficerBoard Member Apr 27, 2021
Debra Johnson Individual Corporate OfficerBoard Member Jan 1, 2008
Jason T Giordano Individual Corporate OfficerBoard Member Jul 26, 2022
Rhonda Green Individual Corporate OfficerBoard Member May 1, 2013
Daisy Vale Individual Corporate OfficerBoard Member Apr 1, 2007
Leonora C Gerspach-Siegel Individual Corporate OfficerBoard Member Apr 22, 2025
Cheryl Ross Individual Corporate OfficerBoard Member Nov 1, 2018
David Jolly Individual Corporate DirectorCeo/President Jan 6, 2023
W-2 Managing EmployeeCeo/President Jan 6, 2023
Elizabeth L Miller Individual Corporate OfficerBoard Member Apr 23, 2024
Daniel Lamb Individual Corporate OfficerBoard Member Apr 25, 2017
Dareshanie D'Arpino Individual Corporate OfficerBoard Member Apr 23, 2024
Amy Ansehl Individual Corporate OfficerBoard Member Apr 27, 2021
Randall Volney Coffill Individual Corporate OfficerBoard Member Jun 27, 2023
Paul Ernenwein Individual Corporate OfficerBoard Member Jan 1, 2014
Inaudy Esposito Individual Corporate OfficerBoard Member Jan 25, 2022

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 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1722556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722556800000",
    "number": "1114757515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROADWAY",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125505514",
            "telephone_number": "845-569-8412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE FAMILY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORNERSTONE FAMILY HEALTHCARE",
        "enumeration_date": "2024-08-02",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-220-3165"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Greater Hudson Valley Family Health Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Newburgh, NY

Sources for this page

Verify at the official NPI Registry.