NPIMap

Organization Active NPI

Anthony L. Jordan Health Corporation

Doing business as Glenwood Gardens

  • Federally Qualified Health Center (FQHC)
  • Rochester, NY
National Provider Identifier
1437424231
Registry record updated Mar 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
2701211R Issued in NY
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
Glenwood Gardens
Practice address
41 Kestrel St
Rochester, NY 14613-2120
Phone
(585) 697-7130
Fax
(585) 697-7131
NPI assigned
Mar 13, 2012
Last updated
Mar 19, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTHONY L. JORDAN HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2012

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

Authorized official

Name
Dr. Bridgette Wiefling, MD
Title
President/Ceo
Phone
(585) 423-2878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 2701211R NY Primary

Addresses

Primary practice location

41 Kestrel St
Rochester, NY 14613-2120

Mailing address

82 Holland Street
Rochester, NY 14605-2131
Phone (585) 423-5800

Other identifiers 5

IdentifierTypeStateIssuer
00384969MedicaidNY
6613OtherNYBLUE CROSS OF ROCHESTER
16467AOtherNYMEDICARE PART B
G0187295590OtherNYBLUE CHOICE OF ROCHESTER
331838OtherNYMEDICARE PART A

Other names 1

  • Glenwood Gardens Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040519001335 NY Part B Supplier - Clinic/Group Practice 8729079785 Receives reassigned benefits from 49 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rochester, NY; Canandaigua, NY
O20120531000011 NY Part A Provider - Federally Qualified Health Center (FQHC) 8729079785 Practice locations: Rochester, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437424231. Details of each certification follow.

Federally qualified health center certification: CCN 331051

Legal name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
JORDAN HEALTH AT GLENWOOD GARDENS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 2012
Last certification
Jul 18, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1973 in NY
Enrollment address
41 Kestrel St
Rochester, NY 14613-2120

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Part of
Anthony L Jordan HLTH C

Locations

41 Kestrel St
Rochester, NY 14613
Phone (585) 423-5837

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Mary L Miller Individual Corporate OfficerChief Dental Officer Mar 1, 2016
Bradley M Turner Individual Corporate Director Jan 14, 2017
Shappelle Thompson Individual Corporate DirectorBoard Member Nov 18, 2010
Clinton Bell Individual Corporate Director Jul 28, 2015
Andrew Doniger Individual Corporate Director Sep 27, 2016
Lashana Boose Individual Corporate DirectorBoard of Director Feb 11, 2021
Sammy Ndive Individual Corporate DirectorBoard Member Jan 29, 2010
Bettina Castro Individual Corporate DirectorBoard of Director Oct 1, 2019
Allen Williams Individual Corporate Director Sep 25, 2013
Janice Harbin Individual Corporate OfficerChief Executive Officer Nov 20, 2012
Jonathan Clune Individual Corporate OfficerChief Financial Officer Nov 11, 2004
Operational/Managerial ControlCfo Nov 11, 2004

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anthony L. Jordan Health CorporationRochester, NY, CCN 331027 Federally qualified health center Operational/Managerial Control Nov 1, 2010
Woodward CenterRochester, NY, CCN 331044 Federally qualified health center Operational/Managerial Control Aug 27, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332115200000",
    "number": "1437424231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 HOLLAND STREET",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131",
            "telephone_number": "585-423-5800",
            "fax_number": "585-423-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 KESTREL ST",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146132120",
            "telephone_number": "585-697-7130",
            "fax_number": "585-697-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-19",
        "status": "A",
        "authorized_official_last_name": "WIEFLING",
        "authorized_official_first_name": "BRIDGETTE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "585-423-2878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "2701211R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00384969",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ROCHESTER",
            "identifier": "6613",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "16467A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE OF ROCHESTER",
            "identifier": "G0187295590",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART A",
            "identifier": "331838",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenwood Gardens",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.