NPIMap

Organization Active NPI

Ryan-Chelsea Clinton Community Health Center

  • Federally Qualified Health Center (FQHC)
  • New York, NY
National Provider Identifier
1215978960
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
1989061 Issued in NY
Legal business name
RYAN-CHELSEA CLINTON COMMUNITY HEALTH CENTER
Practice address
645 10TH Ave
New York, NY 10036
Phone
(212) 265-4500
Fax
(212) 531-7514
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Authorized official

Name
Mr. Daniel Pichinson
Title
Executive Director
Phone
(212) 265-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 1989061 NY Primary

Addresses

Primary practice location

645 10TH Ave
New York, NY 10036

Mailing address

645 10TH Ave
New York, NY 10036
Phone (212) 265-4500

Other identifiers 1

IdentifierTypeStateIssuer
02182103MedicaidNY

Other names 1

  • Ryan Chelsea Clinton C.H.C. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311001283 NY Part B Supplier - Clinic/Group Practice 5193614857 Receives reassigned benefits from 50 practitioners
Practice locations: New York, NY
O20080424000550 NY Part A Provider - Federally Qualified Health Center (FQHC) 5193614857 Practice locations: New York, NY

Federally qualified health center certification: CCN 331906

Legal name
RYAN-CHELSEA CLINTON COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 15, 2002
Last certification
Jan 15, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 9, 1996 in NY
Enrollment address
645 10TH Ave
New York, NY 10036-2904

National Provider Directory

National Provider Directory

Locations

140 W 102nd St
Rm 88
New York, NY 10025

103 W 107th St
New York, NY 10025

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

16 E 16th St
Fl 5
New York, NY 10003
Phone (212) 206-5252

646 10th Ave
New York, NY 10036
Phone (212) 956-1100

442 E Houston St
Rm 219
New York, NY 10002

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
Carmelo Reyes Individual Corporate OfficerBoard Member Nov 1, 2016
Jermel J Hawkins Individual Corporate OfficerBoard Member May 1, 2017
Jose Virella Individual W-2 Managing EmployeeChief Financial Officer Jul 28, 2015
Harriet King Individual Corporate OfficerBoard Member Jan 1, 2011
Margaret Gramins Individual Corporate OfficerBoard Member Jan 1, 2016
Howard M Long Individual Corporate OfficerBoard Member Jan 1, 2015
Brian McIndoe Individual W-2 Managing EmployeeCfo Jul 13, 2009
Walter Delacruz Individual Corporate OfficerBoard Member Oct 1, 2007
Hope Mason Individual Corporate OfficerBoard Member Jun 10, 2010
Ronald Guy Individual Corporate OfficerBoard Member Jan 1, 2007
Daniel Pichinson Individual Corporate DirectorExecutive Director Sep 1, 2017

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 104

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

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706140800000",
    "number": "1215978960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10036",
            "telephone_number": "212-265-4500",
            "fax_number": "212-531-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10036",
            "telephone_number": "212-265-4500",
            "fax_number": "212-531-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN-CHELSEA CLINTON COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A",
        "authorized_official_last_name": "PICHINSON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "212-265-4500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "1989061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02182103",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ryan Chelsea Clinton C.H.C.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ryan Chelsea Clinton C.H.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.