NPIMap

Organization Active NPI

Open Door Family Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mamaroneck, NY
National Provider Identifier
1487194155
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5905200R Issued in NY
Legal business name
OPEN DOOR FAMILY MEDICAL CENTER, INC.
Practice address
689 Mamaroneck Ave
Mamaroneck, NY 10543-5910
Phone
(914) 732-0233
Fax
(914) 732-0234
NPI assigned
Mar 1, 2017
Last updated
Apr 10, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
OPEN DOOR FAMILY MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

Name
Ms. Lindsay C Farrell, MBA, FACMPE
Title
President and Ceo
Phone
(914) 502-1450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 5905200R NY Primary

Addresses

Primary practice location

689 Mamaroneck Ave
Mamaroneck, NY 10543-5910

Mailing address

165 Main St
Ossining, NY 10562-4702
Phone (914) 941-1263

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150224001267 NY Part B Supplier - Clinic/Group Practice 7113835380 Receives reassigned benefits from 162 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yonkers, NY; White Plains, NY; Sleepy Hollow, NY; Saugerties, NY; Port Chester, NY; Ossining, NY; Pelham, NY; Brewster, NY…
O20170517002407 NY Part A Provider - Federally Qualified Health Center (FQHC) 7113835380 Practice locations: Mamaroneck, NY
O20210125002165 NY MDPP Supplier - in-Person MDPP Supplier 7113835380 5 other NPIs on this enrollment
Practice locations: Brewster, NY; Sleepy Hollow, NY; Port Chester, NY; Ossining, NY; Mount Kisco, NY; Mamaroneck, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487194155. Details of each certification follow.

Federally qualified health center certification: CCN 571073

Legal name
OPEN DOOR FAMILY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2017
Last certification
May 19, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 2, 1975 in NY
Enrollment address
689 Mamaroneck Ave
Mamaroneck, NY 10543-5910

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 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2156600Open Door Family Medical Center - Mamaroneck689 Mamaroneck Ave, Mamaroneck, NY 10543Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Robert J Pampin

Locations

30 W Main St
Mount Kisco, NY 10549
Phone (914) 666-3272

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Daysi Briones Individual Corporate DirectorBoard Member May 23, 2018
Dorian Lindsay Individual Corporate Director Mar 1, 2007
Tyler H Beebe Individual Corporate DirectorBoard Member Dec 1, 2009
Daniel Ross Individual Corporate DirectorBoard Member May 25, 2016
Marie Pennaccio Individual Corporate DirectorBoard Member May 20, 2020
Margoth Pilla Individual Corporate Director May 1, 2008
Maria Mazzotta Individual Corporate OfficerCfo Feb 22, 2002
W-2 Managing EmployeeCfo Nov 21, 2005
Operational/Managerial ControlCfo Feb 22, 2002
Andres Valdespino Individual Corporate Director May 1, 2005
Lindsay C Farrell Individual Corporate OfficerPresident / Ceo Oct 1, 1998
W-2 Managing Employee Nov 21, 2005
Operational/Managerial ControlPresident / Ceo Oct 1, 1998
Michele Horvath Individual Corporate DirectorBoard Member May 22, 2019
Barbara Ilardi Individual Corporate DirectorBoard Member May 23, 2018
Blakeley Lowry Individual Corporate DirectorBoard Member May 22, 2019
Samantha Villazan Individual Corporate DirectorBoard Member Apr 28, 2021
Charles Chehebar Individual Corporate DirectorBoard Member May 1, 1997

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.

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1488326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1487194155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 MAIN ST",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624702",
            "telephone_number": "914-941-1263",
            "fax_number": "914-941-8626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "689 MAMARONECK AVE",
            "city": "MAMARONECK",
            "state": "NY",
            "postal_code": "105435910",
            "telephone_number": "914-732-0233",
            "fax_number": "914-732-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR FAMILY MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR FAMILY MEDICAL CENTER, INC.",
        "enumeration_date": "2017-03-01",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "914-502-1450",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MBA, FACMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5905200R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mamaroneck, NY

Sources for this page

Verify at the official NPI Registry.