NPIMap

Organization Active NPI

Bronxcare Health System

Doing business as Family Medicine Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1306190558
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7000001H Issued in NY
Legal business name
BRONXCARE HEALTH SYSTEM
Doing business as
Family Medicine Center
Practice address
1276 Fulton Ave 3Rd Floor
Bronx, NY 10456
Phone
(718) 901-8600
Fax
(718) 293-1475
NPI assigned
Nov 8, 2012
Last updated
Jun 28, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
BRONXCARE HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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

Authorized official

Name
Mr. Victor G Demarco, CPA
Title
Senior VP-Chief Financial Officier
Phone
(718) 901-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7000001H NY Primary

Addresses

Primary practice location

1276 Fulton Ave 3Rd Floor
Bronx, NY 10456

Mailing address

1276 Fulton Ave
Bronx, NY 10456-3402
Phone (718) 901-8600

Other names 1

  • Family Medicine Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130618000790 NY Part A Provider - Federally Qualified Health Center (FQHC) 3870404429 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306190558. Details of each certification follow.

Federally qualified health center certification: CCN 331073

Legal name
BRONXCARE HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 23, 2013
Last certification
Jul 23, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 26, 1962 in NY
Enrollment address
1276 Fulton Ave
Bronx, NY 10456-3467

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
BLHC OB GYN Group28 organizations share this tax ID, including this one
Part of
BLHC OB GYN Group

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Barbara a Lowe Individual Corporate DirectorBoard Member Oct 10, 2000
John R Colon Individual Corporate DirectorBoard Member Jan 9, 2007
Milagros Baez O'Toole Individual Corporate DirectorBoard Member Jan 1, 2013
Miguel Fuentes Individual Corporate OfficerPresident &Ceo May 6, 1987
Corporate DirectorBoard Member May 6, 1987
Cristina Toosie Individual Corporate DirectorBoard Member Jan 9, 1990
Victor G Demarco Individual Corporate OfficerSr. Vice President & Cfo Nov 1, 1999
W-2 Managing Employee Nov 1, 1999
Ricardo R. Fernandez Individual Corporate DirectorBoard Member May 12, 1992
Rita Dimartino Individual Corporate DirectorBoard Member Sep 15, 1987

NPI Registry JSON

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

{
    "created_epoch": "1352332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1306190558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE 3RD FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10456",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONXCARE HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONXCARE HEALTH SYSTEM",
        "enumeration_date": "2012-11-08",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "DEMARCO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SENIOR VP-CHIEF FINANCIAL OFFICIER",
        "authorized_official_telephone_number": "718-901-8600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7000001H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.