NPIMap

Organization Active NPI

Schenectady Family Health Services, Inc.

Doing business as Hometown Health Centers Dental at McClellan Street

  • Dental Clinic/Center
  • Schenectady, NY
National Provider Identifier
1457024218
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SCHENECTADY FAMILY HEALTH SERVICES, INC.
Doing business as
Hometown Health Centers Dental at McClellan Street
Practice address
600 McClellan St
Dental Suite
Schenectady, NY 12304-1009
Phone
(518) 370-1441
Fax
(518) 395-9431
NPI assigned
Jul 28, 2021
Last updated
Aug 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Authorized official

Name
Amy J Cole
Title
Credentialing Manager
Phone
(518) 370-1441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

600 McClellan St
Dental Suite
Schenectady, NY 12304-1009

Mailing address

1044 State St
Schenectady, NY 12307-1508
Phone (518) 370-1441

Other identifiers 3

IdentifierTypeStateIssuer
02995513MedicaidNY
53099AOtherNYMEDICARE PIN
331833OtherNYMEDICARE OSCAR

Other names 1

  • Hometown Health Centers Dental at McClellan Street Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325000143 NY Part B Supplier - Clinic/Group Practice 1850280827 Receives reassigned benefits from 63 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Schenectady, NY
O20230322000096 NY Part A Provider - Federally Qualified Health Center (FQHC) 1850280827 Practice locations: Schenectady, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457024218. Details of each certification follow.

Federally qualified health center certification: CCN 331803

Legal name
SCHENECTADY FAMILY HEALTH SERVICES INC
Doing business as
HOMETOWN HEALTH CENTERS DENTAL AT STATE STREET
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2022
Last certification
Dec 27, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1983 in NY
Enrollment address
1108 State St
Schenectady, NY 12304-2610

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Hometown Health at Nott Street5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1044 State St
Schenectady, NY 12307
Phone (518) 370-1441

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
Evan J Brooksby Individual Corporate DirectorBoard Member Oct 20, 2014
Andrew Bigness Individual Corporate DirectorBoard Member Oct 20, 2014
Catherine a Lewis Individual Corporate DirectorBoard Member Oct 20, 2014
Richard Correa Individual Corporate DirectorBoard Member Oct 20, 2014
William B Faubion Individual Corporate DirectorBoard Member Oct 20, 2014
Donald a Liebers Individual Corporate DirectorBoard Member Oct 20, 2014
Pedro J Aviles Individual Corporate DirectorBoard Member Oct 20, 2014
Timothy Starr Individual Corporate OfficerCfo Dec 1, 2019
Operational/Managerial ControlCfo Dec 1, 2019
Caroline Welch Individual Corporate DirectorBoard Member Oct 20, 2014
Joseph Gambino Individual Corporate OfficerCeo Oct 20, 2014
Operational/Managerial ControlCeo Oct 20, 2014
Ashley Pollock Individual Corporate DirectorBoard Member Oct 20, 2014

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 75

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 75

NPI Registry JSON

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1457024218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 STATE ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123071508",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MCCLELLAN ST",
            "address_2": "DENTAL SUITE",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123041009",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHENECTADY FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-08-18",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "518-370-1441"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995513",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "53099A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OSCAR",
            "identifier": "331833",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hometown Health Centers Dental at McClellan Street",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hometown Health Centers Dental at McClellan Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.