NPIMap

Organization Active NPI

Whitney M. Young, Jr. Health Center, Inc.

  • Community Health Clinic/Center
  • Albany, NY
National Provider Identifier
1366166191
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Practice address
164 Montgomery St
Albany, NY 12207-2420
Phone
(518) 465-4771
NPI assigned
Sep 26, 2022
Organization subpart
Yes
Parent organization
WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Authorized official

Name
David Harold Shippee
Title
President/Ceo
Phone
(518) 591-4459

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

164 Montgomery St
Albany, NY 12207-2420

Mailing address

920 Lark Dr
Albany, NY 12207-1300
Phone (518) 465-4771

Other identifiers 1

IdentifierTypeStateIssuer
00473565MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230313002528 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY

Federally qualified health center certification: CCN 331812

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Doing business as
MOBILE HEALTH - UNIT 2
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2023
Last certification
Mar 10, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 5, 1974 in NY
Enrollment address
164 Montgomery St
Albany, NY 12207-2420

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Whitney M Young Troy Health15 organizations share this tax ID, including this one
Part of
Whitney M Young Troy Health

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Gus Birkhead Individual Corporate DirectorBoard Member Apr 12, 2022
Casey Parker Individual Corporate DirectorBoard Member Apr 6, 2021
Charles Welge Individual Corporate DirectorBoard Member Apr 9, 2024
David Harold Shippee Individual Corporate OfficerCeo Apr 28, 2011
W-2 Managing EmployeeCeo Apr 28, 2011
Marlowe Cochran Individual Corporate DirectorBoard Member Apr 5, 2016
Rosalyn Duvall Individual Corporate DirectorBoard Member Apr 11, 2023
Gary Guy Individual Corporate DirectorBoard Member Apr 11, 2023
Annette Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Sheila Nelson Individual Corporate DirectorBoard Member Apr 4, 2017
Susanne M Isabella Individual Corporate DirectorRevenue Cycle Director Jul 23, 2021
W-2 Managing EmployeeRevenue Cycle Director Jul 23, 2021
Ceylon Moore Individual Corporate DirectorBoard Member Jun 6, 2016
Tracey Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
John E Fraher Individual Corporate OfficerCfo Nov 19, 2018
W-2 Managing EmployeeCfo Nov 19, 2018
Kelli Arnold Individual Corporate DirectorBoard Member May 14, 2024
Lauri Rosmarin-Plattner Individual Corporate DirectorBoard Member Apr 11, 2023

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1366166191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300",
            "telephone_number": "518-465-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 MONTGOMERY ST",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122072420",
            "telephone_number": "518-465-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "SHIPPEE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "518-591-4459"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473565",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.