Northern Oswego County Health Services, Inc.
Organization Active NPI Community Health Clinic/Center · Parish, NY
NPI 1295136604 · NPPES record last updated Sep 5, 2014
Key facts
- NPI
- 1295136604
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
- Practice address
- 639 County Route 22
Parish, NY 13131-3182 - Phone
- (315) 625-5213
- Fax
- (315) 298-7831
- NPI assigned
- Sep 5, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Authorized official
- Name
- Karen Paterniti
- Title
- Chief Financial Officer
- Phone
- (315) 298-6569
Owners & managing parties with NPI records 13
-
Micheal D Stephens, M.D.
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 16
Facilities with the same owner 7
Practitioners 38
-
Maya Marie Abraham, FNP
-
Adekola Alao, M.D.
-
Mary M Barbara, PA
-
David Barber, MD
-
McKenzie Brubaker, FNP
-
Patrick J Carguello, D.O.
-
Celeste I Carnes, NP
-
Marie-Jeanne Desravines, M.D.
-
Annette Digby, FNP
-
Blaze Fahnestock, FNP
-
Thomas Andrew Hanna, M.D.
-
Jody Lee Hipple, FNP
-
Julie E Hogle, LCSW-R
-
Miranda King, NP
-
Valerie McCarthy, MD
-
Michael Miller, MD
-
Lindsay Ogorchock, FNP
-
Megan Michelle Pecha, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Federally qualified health center certification: CCN 331140
- Legal name
- NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 27, 2015
- Last certification
- Feb 27, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 24, 1969 in NY
- Enrollment address
- 22 County Rte
Altmar Parish Williamstown High SCH
Parish, NY 13131
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Tracy Wimmer |
Corporate Officer |
Jul 1, 2018 | 5% |
| W-2 Managing Employee | Mar 7, 2016 | ||
| Judith Catella |
Corporate Director | Apr 1, 1988 | |
| David Dingman |
Corporate Director | Apr 1, 2019 | |
| Steven Gaffney |
Corporate Officer | Apr 1, 2020 | |
| Tricia Peter Clark |
Corporate Officer |
Jun 4, 2021 | 5% |
| W-2 Managing Employee | Jul 26, 2004 | ||
| Michael Backus |
Corporate Officer | Apr 1, 2015 | |
| Robert Trainham |
Corporate Director | Apr 1, 2015 | |
| Timothy McCluskey |
Corporate Officer |
Apr 1, 2007 | |
| Felicity Hallanan |
Corporate Director | Jun 1, 2007 | |
| Kathleen McLeod |
Corporate Director | Jan 2, 2007 | |
| James Oldenburg |
Corporate Director | Apr 1, 2018 | |
| Susan Lobdell |
Corporate Director | Apr 1, 2018 | |
| Micheal D Stephens |
Corporate Director | Apr 1, 2020 | |
| Robert Oustrich |
Corporate Director | Apr 1, 2017 | |
| Northern Oswego County Health Services, Inc. |
Operational/Managerial Control | Jan 20, 2008 | 100% |
| Lauren Seiter |
Corporate Director | Apr 1, 2016 | |
| Rose Ann Jerrett |
Corporate Director | Apr 1, 2016 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2013 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2013 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2013 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Oct 1, 2012 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 24, 2014 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 28, 2004 |
| Northern Oswego County Health Services, Inc. |
Federally qualified health center | Operational/Managerial Control (100%) | Feb 28, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150227000231 | NY | Part a Provider - Federally Qualified Health Center (FQHC) | 8426961541 | Practice locations: Parish, NY |
National Provider Directory
- Tax ID family
- Northern Oswego Co Heal
- Part of
- Northern Oswego Co Heal
Locations
3045 East Ave
Ste G400
Central Square, NY 13036
Phone (315) 675-9200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
639 County Route 22
Parish, NY 13131-3182
Mailing address
639 County Route 22
Parish, NY 13131-3182
Phone (315) 625-5213
Other names
- APW High School Based Health Center
Other providers in Parish, NY
- Carol M Lembo
- Shayla Lobello
- Mikala L Morse
- Peyton Elizabeth Nadeau
- Northern Oswego County Health Services, Inc.
- Northern Oswego County Health Services, Inc.
- Shawna Nutting
- Shannon Marie Priest
- Hope Rayder
- Rebecca Rossman
All providers in Parish, NY · Community Health Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.