NPIMap

Organization Active NPI

Sun River Health Inc

  • Federally Qualified Health Center (FQHC)
  • Staten Island, NY
National Provider Identifier
1174006803
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5901200R Issued in NY
Legal business name
SUN RIVER HEALTH INC
Practice address
57 Bay Street
Bay Street Health Center
Staten Island, NY 10301-2510
Phone
(855) 681-8700
Fax
(718) 442-1521
NPI assigned
Sep 10, 2018
Organization subpart
Yes
Parent organization
SUN RIVER HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Adam K. Lipton
Title
VP Info/Practice MGMT Systems
Phone
(914) 384-2375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 5901200R NY Primary

Addresses

Primary practice location

57 Bay Street
Bay Street Health Center
Staten Island, NY 10301-2510

Mailing address

PO Box 5036
White Plains, NY 10602-5036
Phone (914) 734-8800

Other identifiers 2

IdentifierTypeStateIssuer
00473038MedicaidNY
W38731OtherNYGROUP MEDICARE

Other names 1

  • Bay Street Health Center Other name

National Provider Directory

National Provider Directory
Tax ID family
John T Raffalli17 organizations share this tax ID, including this one
Part of
John T Raffalli

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1174006803",
    "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": "57 BAY STREET",
            "address_2": "BAY STREET HEALTH CENTER",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103012510",
            "telephone_number": "855-681-8700",
            "fax_number": "718-442-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN RIVER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUN RIVER HEALTH INC",
        "enumeration_date": "2018-09-10",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "LIPTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "VP INFO/PRACTICE MGMT SYSTEMS",
        "authorized_official_telephone_number": "914-384-2375"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5901200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473038",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "W38731",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Street Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bay Street Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.