NPIMap

Organization Active NPI

Damian Family Care Centers, Inc.

Doing business as Project Samaritan Health Services

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1245329168
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7003246R Issued in NY
Legal business name
DAMIAN FAMILY CARE CENTERS, INC.
Doing business as
Project Samaritan Health Services
Practice address
1381 University Avenue
Bronx, NY 10452
Phone
(718) 538-7000
Fax
(718) 538-2805
NPI assigned
Oct 11, 2006
Last updated
Aug 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Peter Grisafi
Title
Ceo
Phone
(718) 657-1100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NY
Federally Qualified Health Center (FQHC) 261QF0400X 7003246R NY Primary

Addresses

Primary practice location

1381 University Avenue
Bronx, NY 10452

Mailing address

8956 162ND St FL 3
Jamaica, NY 11432-5072
Phone (718) 657-1100

Other identifiers 1

IdentifierTypeStateIssuer
01690633MedicaidNY

Other names 1

  • Project Samaritan Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210929002009 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507849882 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245329168. Details of each certification follow.

Federally qualified health center certification: CCN 571818

Legal name
DAMIAN FAMILY CARE CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2021
Last certification
Oct 1, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 24, 2011 in NY
Enrollment address
1381 University Ave
Bronx, NY 10452-4005

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory

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
John Tavolacci Individual Corporate DirectorBoard Member Jun 21, 2016
Peter Grisafi Individual Corporate OfficerCeo Nov 1, 2013
Corporate DirectorBoard Member Feb 29, 1996
W-2 Managing EmployeeCeo Nov 1, 2013
Junnie E Campbell Individual Corporate OfficerSecretary Jul 1, 2003
Corporate DirectorSecretary Jul 1, 2003
Operational/Managerial Control Jul 1, 2003
Arismendi Jimenez Individual Corporate DirectorBoard Member Mar 21, 2017
Michael Degraffenreid Individual Corporate Director Sep 1, 2011
Cynthia Cortes Individual Corporate Director Oct 1, 2013
Janet Moss Individual Corporate Director Sep 1, 2010
Idania Lopez Mercado Individual Corporate Director Aug 16, 2016
Evdoxia Pittas Individual Corporate DirectorBoard Member Mar 21, 2017
Stephanie James Individual Corporate Director Jun 15, 2004
Gordon Siess Individual Corporate OfficerCfo Oct 8, 2020
Jane Velez Individual Corporate OfficerBoard Vice Chair Person Feb 29, 1996
Corporate DirectorBoard Member Jun 15, 2004
Operational/Managerial ControlBoard Vice Chair Person Feb 29, 1996
Chinyere Eze-Nliam Individual Corporate Director Mar 29, 2016

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1245329168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8956 162ND ST FL 3",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114325072",
            "telephone_number": "718-657-1100",
            "fax_number": "718-657-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 UNIVERSITY AVENUE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10452",
            "telephone_number": "718-538-7000",
            "fax_number": "718-538-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMIAN FAMILY CARE CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "GRISAFI",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-657-1100"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7003246R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01690633",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Project Samaritan Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Project Samaritan Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.