NPIMap

Organization Active NPI

Whitney M. Young Jr. Health Center, Inc.

  • Community Health Clinic/Center
  • Albany, NY
National Provider Identifier
1235537655
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
0101205R Issued in NY
Legal business name
WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Practice address
920 Lark Dr
Whitney M. Young Jr. Health Center - Mobile Van
Albany, NY 12207-1300
Phone
(518) 465-4771
Fax
(518) 320-3022
NPI assigned
Dec 17, 2014
Organization subpart
Yes
Parent organization
WHITNEY M. YOUNG JR. HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Authorized official

Name
David H Shippee
Title
Ceo/President
Phone
(518) 465-4771

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 0101205R NY Primary
Federally Qualified Health Center (FQHC) 261QF0400X 0101205R NY
Primary Care Clinic/Center 261QP2300X 010120R NY

Addresses

Primary practice location

920 Lark Dr
Whitney M. Young Jr. Health Center - Mobile Van
Albany, NY 12207-1300

Mailing address

320 Seventh Avenue
Troy, NY 12182
Phone (518) 465-4771

Other identifiers 1

IdentifierTypeStateIssuer
00473565MedicaidNY

Other names 1

  • Mobile Van Unit Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040821000073 NY Part B Supplier - Clinic/Group Practice 6507830031 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albany, NY; Troy, NY; Watervliet, NY
O20160311000226 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY

Federally qualified health center certification: CCN 571067

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Doing business as
WYH MOBILE HEALTH UNIT - WOW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 20, 2017
Last certification
Mar 20, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 5, 1974 in NY
Enrollment address
900 Lark Dr
Albany, NY 12207-1339

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 5

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

National Provider Directory

National Provider Directory
Tax ID family
Whitney M Young Troy Health15 organizations share this tax ID, including this one
Part of
Whitney M Young Troy Health

Other organizations with this tax ID 14

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

View all 14

Locations

320 7th Ave
Troy, NY 12182
Phone (518) 233-6811

Ownership & related parties

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.

NameRoleSinceShare
Gus Birkhead Individual Corporate DirectorBoard Member Apr 12, 2022
Casey Parker Individual Corporate DirectorBoard Member Apr 6, 2021
Charles Welge Individual Corporate DirectorBoard Member Apr 9, 2024
David Harold Shippee Individual Corporate OfficerCeo/President Apr 28, 2011 100%
W-2 Managing EmployeeCeo/President Apr 28, 2011
Marlowe Cochran Individual Corporate DirectorBoard Member Apr 5, 2016
Rosalyn Duvall Individual Corporate DirectorBoard Member Apr 11, 2023
Gary Guy Individual Corporate DirectorBoard Member Apr 11, 2023
Annette Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Sheila Nelson Individual Corporate DirectorBoard Member Apr 4, 2017
Susanne M Isabella Individual Corporate DirectorRevenue Cycle Director Jul 23, 2021
W-2 Managing EmployeeRevenue Cycle Director Jul 23, 2021
Ceylon Moore Individual Corporate DirectorBoard Member Jun 6, 2016
Tracey Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
John E Fraher Individual Corporate DirectorCfo Nov 19, 2018
W-2 Managing EmployeeCfo Nov 19, 2018
Kelli Arnold Individual Corporate DirectorBoard Member May 14, 2024
Lauri Rosmarin-Plattner Individual Corporate DirectorBoard Member Apr 11, 2023

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1235537655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 SEVENTH AVENUE",
            "city": "TROY",
            "state": "NY",
            "postal_code": "12182",
            "telephone_number": "518-465-4771",
            "fax_number": "518-320-3022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "address_2": "WHITNEY M. YOUNG JR. HEALTH CENTER - MOBILE VAN",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300",
            "telephone_number": "518-465-4771",
            "fax_number": "518-320-3022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY M. YOUNG JR. HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITNEY M. YOUNG JR. HEALTH CENTER, INC.",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "SHIPPEE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "518-465-4771"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NY",
            "license": "0101205R",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "0101205R",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "010120R",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473565",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Van Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.