NPIMap

Organization Active NPI

Schenectady Family Health Services, Inc.

  • Family Medicine Physician
  • Amsterdam, NY
National Provider Identifier
1174947469
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SCHENECTADY FAMILY HEALTH SERVICES, INC.
Practice address
67 Division St Ste 2
Amsterdam, NY 12010-4099
Phone
(518) 627-2110
Fax
(518) 627-2112
NPI assigned
Feb 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Authorized official

Name
Joseph Gambino
Title
Ceo
Phone
(518) 370-1441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

67 Division St Ste 2
Amsterdam, NY 12010-4099

Mailing address

1044 State St
Schenectady, NY 12307-1508
Phone (518) 370-1441

Other identifiers 3

IdentifierTypeStateIssuer
53099AOtherNYMEDICARE PIN
02995513MedicaidNY
331833OtherNYMEDICARE OSCAR

Other names 1

  • Hometown Health Centers at Amsterdam Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170925001061 NY Part A Provider - Federally Qualified Health Center (FQHC) 1850280827 Practice locations: Amsterdam, NY

Federally qualified health center certification: CCN 571084

Legal name
SCHENECTADY FAMILY HEALTH SERVICES INC
Doing business as
HOMETOWN HEALTH CENTERS AT AMSTERDAM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 2017
Last certification
Oct 2, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 20, 2014 in NY
Enrollment address
67 Division St
Ste 2
Amsterdam, NY 12010-4099

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Hometown Health at Nott Street5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

67 Division St
Ste 2
Amsterdam, NY 12010
Phone (518) 627-2110

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
Evan J Brooksby Individual Corporate DirectorBoard Member Oct 20, 2014
Andrew Bigness Individual Corporate DirectorBoard Member Jan 24, 2019
Catherine a Lewis Individual Corporate DirectorBoard Member Oct 20, 2014
Richard Correa Individual Corporate DirectorBoard Member Oct 20, 2014
William B Faubion Individual Corporate DirectorBoard Member Oct 20, 2014
Donald a Liebers Individual Corporate DirectorBoard Member Oct 20, 2014
David Smingler Individual Corporate DirectorBoard Member Oct 20, 2014
Pedro J Aviles Individual Corporate DirectorBoard Member Oct 20, 2014
Timothy Starr Individual Corporate OfficerCfo Dec 1, 2019
Operational/Managerial ControlCfo Dec 1, 2019
Caroline Welch Individual Corporate DirectorBoard Member Oct 20, 2014
Joseph Gambino Individual Corporate OfficerCeo Oct 20, 2014
Operational/Managerial ControlCeo Oct 20, 2014
Nichele Darby Individual Corporate DirectorBoard Member Jan 24, 2019
Ashley Pollock Individual Corporate DirectorBoard Member Oct 20, 2014

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 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1174947469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 STATE ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123071508",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 DIVISION ST STE 2",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120104099",
            "telephone_number": "518-627-2110",
            "fax_number": "518-627-2112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHENECTADY FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "GAMBINO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "518-370-1441"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "53099A",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995513",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OSCAR",
            "identifier": "331833",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Health Centers at Amsterdam",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hometown Health Centers at Amsterdam",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amsterdam, NY

Sources for this page

Verify at the official NPI Registry.