NPIMap

Organization Active NPI

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

  • Community Health Clinic/Center
  • Albany, NY
National Provider Identifier
1417924762
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
0101205R Issued in NY
Legal business name
WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Practice address
920 Lark Dr
Albany, NY 12207-1300
Phone
(518) 533-3136
Fax
(518) 432-8712
NPI assigned
Mar 7, 2006
Last updated
Nov 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 0101205R NY Primary

Addresses

Primary practice location

920 Lark Dr
Albany, NY 12207-1300

Mailing address

920 Lark Dr
Albany, NY 12207-1300
Phone (518) 533-3136

Other identifiers 1

IdentifierTypeStateIssuer
00473565MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040821000073 NY Part B Supplier - Clinic/Group Practice 6507830031 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
Practice locations: Albany, NY; Troy, NY; Watervliet, NY
O20080303000422 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, NY
O20100303000647 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1417924762. Details of each certification follow.

Federally qualified health center certification: CCN 331980

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 3, 2008
Last certification
Apr 3, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 5, 1974 in NY
Enrollment address
6 102ND St
Troy, NY 12180-1152

Federally qualified health center certification: CCN 331807

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
920 Lark Dr
Albany, NY 12207-1300

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Darrell Jeffers Individual Corporate DirectorBoard Member Apr 13, 2004
Carol Hausaman Individual Corporate DirectorBoard Member Sep 14, 2008
David Harold Shippee Individual W-2 Managing Employee Apr 28, 2011
Corporate DirectorCeo/President Apr 23, 2011
W-2 Managing EmployeeCeo/President Apr 23, 2011
Operational/Managerial ControlCeo/President Apr 23, 2011 100%
Marlowe Cochran Individual Corporate DirectorBoard Member Apr 5, 2016
Antoine Harrison Individual Corporate DirectorBoard Member Apr 7, 2015
Nischinth Sadhak Individual Corporate DirectorBoard Member Apr 5, 2016
Glinnesa Gailliard Individual Corporate DirectorBoard Member Mar 1, 2016
Mary Connolly Individual W-2 Managing Employee Dec 23, 2004
Denard Cummings Individual Corporate DirectorBoard Member Mar 1, 2016
Ceylon Moore Individual Corporate DirectorBoard Member Jun 6, 2006
Gail Waring Individual Corporate DirectorBoard Member Jan 8, 2013
La'Keysha Marshall Individual Corporate DirectorDirector of Revenue Cycle Mar 24, 2025
W-2 Managing EmployeeDirector of Revenue Cycle Mar 24, 2025
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
Gary Guy Individual Corporate DirectorBoard Member Apr 11, 2023
Annette Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Nathan Gardner Individual Corporate DirectorBoard Member Apr 8, 2025
Christopher Chase Individual Corporate DirectorBoard Member Apr 8, 2025
Tracey Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Anthony Thompson Individual Corporate DirectorBoard Member Apr 8, 2025
John E Fraher Individual Corporate DirectorCfo Nov 19, 2018
W-2 Managing Employee Nov 19, 2018
Kelli Arnold Individual Corporate DirectorBoard Member May 14, 2024
Lauri Rosmarin-Plattner Individual Corporate DirectorBoard Member Apr 11, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1417924762",
    "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": "518-533-3136",
            "fax_number": "518-432-8712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300",
            "telephone_number": "518-533-3136",
            "fax_number": "518-432-8712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "SHIPPEE",
        "authorized_official_first_name": "DAVID",
        "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": "NY",
            "license": "0101205R",
            "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.