NPIMap

Organization Active NPI

Urban Health Plan, Inc.

Doing business as Vida Guidance Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1316446586
Registry record updated Feb 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
URBAN HEALTH PLAN, INC.
Doing business as
Vida Guidance Center
Practice address
4419 3Rd Ave
Bronx, NY 10457-2562
Phone
(718) 364-7700
Fax
(718) 364-1513
NPI assigned
Feb 2, 2018
Last updated
Feb 2, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2018

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

Authorized official

Name
Ms. Paloma Hernandez
Title
President and Ceo
Phone
(718) 589-2440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

4419 3Rd Ave
Bronx, NY 10457-2562

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other identifiers 1

IdentifierTypeStateIssuer
W03211OtherNYOSCAR

Other names 1

  • VIDA GUIDANCE CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180619000956 NY Part A Provider - Federally Qualified Health Center (FQHC) 3173517281 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316446586. Details of each certification follow.

Federally qualified health center certification: CCN 571119

Legal name
URBAN HEALTH PLAN INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 26, 2018
Last certification
Jun 26, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 24, 1974 in NY
Enrollment address
4419 3Rd Ave
Bronx, NY 10457-2562

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Marie a Belotte M D27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

1065 Southern Blvd
Bronx, NY 10459
Phone 71858924404222

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Paloma Hernandez Individual Corporate OfficerPresident and Ceo May 1, 1986
Corporate DirectorPresident and Ceo May 1, 1986
W-2 Managing EmployeePresident and Ceo May 1, 1986
Operational/Managerial ControlPresident and Ceo May 1, 1986
Janette Stanford Individual Corporate DirectorBoard Member Jan 1, 2023
Rhynna Santos Individual Corporate DirectorBoard Member Sep 26, 2019
Joan Rivera-Baker Individual Corporate OfficerBoard Member/Secretary Jan 1, 2009
Linda Baldwin Individual Corporate OfficerBoard Member Jun 15, 1998
Charles Gonzalez Individual Corporate OfficerBoard Member Jun 15, 1998
Edward S Butts Individual Corporate OfficerBoard Member Jan 1, 2011
Clifford Charles Individual Corporate OfficerBoard Treasurer Mar 23, 2009
Oswaldo a Guzman Individual Corporate OfficerBoard Member Jan 1, 2013
Howard Hinestroza Individual Corporate OfficerBoard Member Oct 27, 2016
Yoselin Genao Individual Corporate OfficerBoard Member Nov 15, 2016
Robert C Alvis Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1517529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517529600000",
    "number": "1316446586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440",
            "fax_number": "718-991-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4419 3RD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104572562",
            "telephone_number": "718-364-7700",
            "fax_number": "718-364-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-02",
        "last_updated": "2018-02-02",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "PALOMA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "718-589-2440",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSCAR",
            "identifier": "W03211",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VIDA GUIDANCE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.