Sun River Health Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SUN RIVER HEALTH INC

Practice address

82 Middle Country Rd
Coram, NY 11727-4460

Phone

(631) 320-2220

Fax

(631) 320-2236

NPI assigned

May 11, 2012

Last updated

Mar 13, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

SUN RIVER HEALTH INCAs reported in NPPES

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

Authorized official

Name

Adam Lipton

Title

VP Info/Practice MGMT Systems

Phone

(914) 384-2375

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Elsie Owens Health Center Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437418456. Details of each certification follow.

• CCN 331048 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 331048

Legal name

SUN RIVER HEALTH INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jul 26, 2012

Last certification

Jul 26, 2012

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 5, 1975 in NY

Enrollment address

82 Middle Country Rd
Coram, NY 11727-4460

Other NPIs on the same Medicare enrollment 1

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

• Sun River Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Peekskill, NY
  • NPI 1619969458

  O20120607000702

  Same enrollment

Part of

Frank B Dorsa

All disclosed owners & managing parties 17

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

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

{
    "created_epoch": "1336694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647129600000",
    "number": "1437418456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5036",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106025036",
            "telephone_number": "914-734-8800",
            "fax_number": "914-734-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MIDDLE COUNTRY RD",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117274460",
            "telephone_number": "631-320-2220",
            "fax_number": "631-320-2236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN RIVER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUN RIVER HEALTH INC",
        "enumeration_date": "2012-05-11",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A",
        "authorized_official_last_name": "LIPTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "VP INFO/PRACTICE MGMT SYSTEMS",
        "authorized_official_telephone_number": "914-384-2375"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473038",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elsie Owens Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Elsie Owens Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Katelin Swain, PA-C
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• Lauren Tableman, PMHNP

• Federally Qualified Health Center (FQHC) in Coram, NY
• Providers in Coram, 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 Mar 13, 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.