NPIMap

Organization Active NPI

Open Door Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Port Chester, NY
National Provider Identifier
1285893719
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5905200R Issued in NY
Legal business name
OPEN DOOR FAMILY MEDICAL CENTER INC
Practice address
5 Grace Church St
Port Chester, NY 10573-4911
Phone
(914) 937-8899
Fax
(914) 933-2740
NPI assigned
Jun 9, 2008
Last updated
Jun 9, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
OPEN DOOR FAMILY MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Ms. Lindsay C. Farrell, MBA FACMPE
Title
President and Ceo
Phone
(914) 502-1450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 5905200R NY Primary

Addresses

Primary practice location

5 Grace Church St
Port Chester, NY 10573-4911

Mailing address

165 Main St
Ossining, NY 10562-4702
Phone (914) 502-1470

Other identifiers 1

IdentifierTypeStateIssuer
00473029MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20021205000026 NY Part A Provider - Federally Qualified Health Center (FQHC) 7113835380 1 other NPI on this enrollment
Practice locations: Port Chester, NY
O20150224001267 NY Part B Supplier - Clinic/Group Practice 7113835380 Receives reassigned benefits from 162 practitioners
6 other NPIs on this enrollment
Practice locations: Yonkers, NY; White Plains, NY; Sleepy Hollow, NY; Saugerties, NY; Port Chester, NY; Ossining, NY; Pelham, NY; Brewster, NY…
O20210125002165 NY MDPP Supplier - in-Person MDPP Supplier 7113835380 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brewster, NY; Sleepy Hollow, NY; Port Chester, NY; Ossining, NY; Mount Kisco, NY; Mamaroneck, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285893719. Details of each certification follow.

Federally qualified health center certification: CCN 331908

Legal name
OPEN DOOR FAMILY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2002
Last certification
Dec 15, 2002
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 2, 1975 in NY
Enrollment address
5 Grace Church St
Port Chester, NY 10573-4911

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2156599Open Door Family Medical Center - Port Chester5 Grace Church Street, Port Chester, NY 10573Provider-performed microscopyMar 26, 2027

National Provider Directory

National Provider Directory
Part of
C P Lucas

Locations

165 Main St
Ossining, NY 10562
Phone (914) 941-1263

5 Grace Church St
Port Chester, NY 10573
Phone (914) 937-8899

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EAJCAA

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
Daysi Briones Individual Corporate DirectorBoard Member May 23, 2018
Dorian Lindsay Individual Corporate DirectorBoard Member Mar 1, 2007
Tyler H Beebe Individual Corporate DirectorBoard Member Dec 1, 2009
David Whitlinger Individual Corporate Director May 24, 2017
Loretta Molinari Individual Corporate DirectorBoard Member May 22, 2013
Daniel Ross Individual Corporate DirectorBoard Member May 25, 2016
Margoth Pilla Individual Corporate DirectorBoard Member May 1, 2008
Maria Mazzotta Individual Corporate OfficerCfo Feb 22, 2002
W-2 Managing EmployeeCfo Oct 25, 1999
Operational/Managerial ControlCfo Feb 22, 2002
Andres Valdespino Individual Corporate DirectorBoard Member Oct 19, 2005
Lindsay C Farrell Individual Corporate OfficerPresident & Ceo Oct 1, 1998
W-2 Managing EmployeePresident/Creo Oct 21, 1998
Operational/Managerial ControlPresident & Ceo Oct 1, 1998
Shirley Buontempo Individual Corporate Director Jan 22, 2014
Charles Chehebar Individual Corporate DirectorBoard Member May 1, 1997
Walter C Edge Individual Corporate DirectorBoard Member Jan 13, 2003

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 165

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.

View all 165

NPI Registry JSON

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

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1285893719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 MAIN ST",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624702",
            "telephone_number": "914-502-1470",
            "fax_number": "914-762-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GRACE CHURCH ST",
            "city": "PORT CHESTER",
            "state": "NY",
            "postal_code": "105734911",
            "telephone_number": "914-937-8899",
            "fax_number": "914-933-2740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR FAMILY MEDICAL CENTER INC",
        "enumeration_date": "2008-06-09",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "914-502-1450",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA FACMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5905200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473029",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Chester, NY

Sources for this page

Verify at the official NPI Registry.