Family Health Network of Central New York, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC

Doing business as

SBHC-DeRuyter Central School

Practice address

711 Railroad St
De Ruyter, NY 13052-9700

Phone

(315) 852-3400

Fax

(607) 662-4916

NPI assigned

Jan 19, 2022

Last updated

Jan 19, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INCAs reported in NPPES

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

Authorized official

Name

Kimberly Osborne

Title

Ceo

Phone

(607) 753-3797

Specialties & licenses 1

Addresses

Other names 1

• SBHC-DeRuyter Central School Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407508708. Details of each certification follow.

• CCN 571828 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 571828

Legal name

SBHC-DERUYTER CENTRAL SCHOOL

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 24, 2022

Last certification

Feb 24, 2022

Ownership / control type

For profit – corporation

Facility address

711 Railroad St
De Ruyter, NY 13052

Part of

Family Health Network O

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Family Health Network of Central New York, Inc.

  • Federally Qualified Health Center (FQHC)
  • Homer, NY
  • NPI 1043374853
  NPPES parent name

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1407508708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S WEST ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771542",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 RAILROAD ST",
            "city": "DE RUYTER",
            "state": "NY",
            "postal_code": "130529700",
            "telephone_number": "315-852-3400",
            "fax_number": "607-662-4916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "607-753-3797"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SBHC-DeRuyter Central School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Blythe Degear, PT
• Deruyter Central School
• Deruyter Health Center
• Colleen June English, L.P.N
• Kathleen Jane Fitzgerald, FNP
• Alysia Irene Gallerani
• Rebecca Irene Hampton, LPN
• Sandra Louise Hathaway, RN
• Lisa M Merchant, LPN

• Federally Qualified Health Center (FQHC) in De Ruyter, NY
• Providers in De Ruyter, NY by specialty
• Federally Qualified Health Center (FQHC) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.