Sun River Health Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

5901200R Issued in NY

Legal business name

SUN RIVER HEALTH INC

Practice address

84 N Highland Ave
Nyack, NY 10960-1831

Phone

(845) 770-9980

Fax

(845) 765-9377

NPI assigned

Jul 8, 2016

Last updated

Mar 13, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

SUN RIVER HEALTH INCAs reported in NPPES

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

Authorized official

Name

Adam Lipton

Title

VP Info/Practice MGMT Systems

Phone

(914) 384-2375

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• HRHCare Nyack Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205288750. Details of each certification follow.

• CCN 571007 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 571007

Legal name

SUN RIVER HEALTH INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Sep 13, 2016

Last certification

Sep 13, 2016

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 5, 1975 in NY

Enrollment address

84 N Highland Ave
Nyack, NY 10960-1831

Other NPIs on the same Medicare enrollment 1

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

• Sun River Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Peekskill, NY
  • NPI 1619969458

  O20160804001012

  Same enrollment

Part of

Frank B Dorsa

All disclosed owners & managing parties 15

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

Practitioners 2

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.

• Jinette Grullon, MPAS RPA-C

  • Physician Assistant
  • Bronx, NY
  • NPI 1033238910
  NPD (past)
• Alyssa Nicole Tharp, PA-C

  • Physician Assistant
  • Valley Cottage, NY
  • NPI 1174228357
  NPD (past)

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

{
    "created_epoch": "1467936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647129600000",
    "number": "1205288750",
    "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": "84 N HIGHLAND AVE",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109601831",
            "telephone_number": "845-770-9980",
            "fax_number": "845-765-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN RIVER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUN RIVER HEALTH INC",
        "enumeration_date": "2016-07-08",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A",
        "authorized_official_last_name": "LIPTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "VP INFO/PRACTICE MGMT SYSTEMS",
        "authorized_official_telephone_number": "914-384-2375"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HRHCare Nyack",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "HRHCare Nyack",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Courtney Lia Sturm, M.S, CCC-SLP
• Cara Danielle Sullivan
• Bridget Barbara Suma, MPS, LCAT
• Summit Childrens Residence Center
• Summit School
• Sundala Wellness, Inc
• Mark H. Susman, MD
• Kenneth Barry Svensson, M.D.
• Tonya Swartzendruber, LMHC
• Noemi Patricia Szriftgiser, M.A.,L.M.H.C.

• Federally Qualified Health Center (FQHC) in Nyack, NY
• Providers in Nyack, NY by specialty
• Federally Qualified Health Center (FQHC) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.