NPIMap

Organization Active NPI

Mosaic Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rushville, NY
National Provider Identifier
1336984178
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOSAIC HEALTH, INC.
Practice address
4100 Baldwin Rd
Rushville, NY 14544-9738
Phone
(585) 287-8844
NPI assigned
Jun 25, 2024
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
Lisa Olscamp
Title
Cfo
Phone
(585) 287-8858

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Student Health Clinic/Center 261QS1000X NU

Addresses

Primary practice location

4100 Baldwin Rd
Rushville, NY 14544-9738

Mailing address

1 S Washington St Ste 300
Rochester, NY 14614-1134
Phone (585) 325-2280

Other identifiers 1

IdentifierTypeStateIssuer
00618199MedicaidNY

Other names 1

  • Rochester Primary Care Network, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240912003187 NY Part A Provider - Federally Qualified Health Center (FQHC) 4385826585 Practice locations: Rushville, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336984178. Details of each certification follow.

Federally qualified health center certification: CCN 571872

Legal name
MOSAIC HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 2024
Last certification
Sep 12, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1987 in NY
Enrollment address
4100 Baldwin Rd
RM 426-428
Rushville, NY 14544-9738

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Mosaic Health Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

4100 Baldwin Rd
Rm 426428
Rushville, NY 14544
Phone (585) 287-8844

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Shana Dahlin Individual Corporate DirectorBoard Member Aug 12, 2024
Dominic Galante Individual Corporate DirectorBoard Member Aug 12, 2024
Kevin P Loughran Individual Corporate DirectorBoard Member Aug 12, 2024
Michael J Leary Individual W-2 Managing EmployeeAd; Sep 15, 2008
Lisa Olscamp Individual W-2 Managing EmployeeAd; Aug 17, 2009
Gerald Giudice Individual Corporate DirectorBoard Member Aug 12, 2024
George Haizlip Individual Corporate DirectorBoard Member Aug 12, 2024
John C Gleason Individual Corporate DirectorBoard Member Aug 12, 2024
Lydia I Rivera-Warr Individual Corporate DirectorBoard Member Aug 12, 2024
Susan Hustleby Individual Corporate DirectorBoard Member Aug 12, 2024

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1719273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1336984178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S WASHINGTON ST STE 300",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146141134",
            "telephone_number": "585-325-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 BALDWIN RD",
            "city": "RUSHVILLE",
            "state": "NY",
            "postal_code": "145449738",
            "telephone_number": "585-287-8844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-25",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "OLSCAMP",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "585-287-8858"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00618199",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rochester Primary Care Network, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Rochester Primary Care Network, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rushville, NY

Sources for this page

Verify at the official NPI Registry.