Syracuse Community Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Syracuse, NY
NPI 1497796353 · NPPES record last updated Jun 5, 2024
Key facts
- NPI
- 1497796353
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SYRACUSE COMMUNITY HEALTH CENTER, INC.
- Practice address
- 930 S Salina St
Syracuse, NY 13202-3530 - Phone
- (315) 476-7921
- NPI assigned
- Jun 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Kerri D Warner
- Title
- Director of Revenue Cycle Managment
- Phone
- (315) 476-7921
Owners & managing parties with NPI records 2
-
Ofrona A Reid, M.D.
-
Brian W Thompson, MD
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 2
Practitioners 150
-
Sunny P Aslam, MD
-
Ritu Bajaj, OD
-
Danielle Marie Bannigan, LCSW
-
Dana Christine Beebe, FNP
-
Caroline Berrios, N.P.
-
Linda L Confer, LCSW
-
Samantha Conklin, FNP-C
-
Eileen Essi, LCSW
-
Blair Carling Germain, O.D.
-
Erin Marie Healy, FNP-C
-
Aimee Hillman, NP
-
Bill C Hines, MD
-
Harold Horowitz, DPM
-
Matthew Jones, FNP
-
Christopher Montanaro, D.C.
-
Dozienze Nwoke, M.D.
-
Ofrona A Reid, M.D.
-
Robert Dwight Semlear, M.D.
-
Jaime Sheffler, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Federally qualified health center certification: CCN 331809
- Legal name
- SYRACUSE COMMUNITY HEALTH CENTER INC
- Doing business as
- SYRACUSE COMMUNITY HEALTH
- 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
- Corporation · Non-profit
- Incorporated
- Apr 1, 1978 in NY
- Enrollment address
- 819 S Salina St
Syracuse, NY 13202-3527
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Raymond Blackwell |
Corporate Director |
Jan 1, 2018 | |
| Emily Demarche |
Corporate Officer |
Jan 1, 2018 | |
| Ben Moore |
Corporate Director |
Jan 1, 2018 | |
| Calvin Corriders |
Corporate Director |
Jan 1, 2018 | |
| Harry Thompson |
Corporate Director |
Jan 1, 2018 | |
| Stephen Markley |
Corporate Director |
Jan 1, 2018 | |
| Agnes McCray |
Corporate Director |
Jan 1, 2018 | |
| Cheryl Vitaletti |
Corporate Director |
Jan 1, 2018 | |
| Kevin Randall |
Corporate Director |
Jan 1, 2018 | |
| Vanessa Bogan |
Corporate Director |
Jan 1, 2018 | |
| Michael Wolfson |
Corporate Director |
Jan 1, 2018 | |
| W Steven Williams |
Corporate Director |
Jan 1, 2018 | |
| Paula Freedom |
Corporate Director |
Jan 1, 2018 | |
| Ofrona a Reid |
Corporate Officer | Jan 1, 2024 | |
| W-2 Managing Employee | Jan 1, 2024 | ||
| Operational/Managerial Control | Jan 1, 2024 | ||
| Charles P Conole |
Corporate Director |
Jan 1, 2018 | |
| Bruce Conner |
Corporate Director |
Jan 1, 2018 | |
| Brian W Thompson |
Corporate Director |
Jan 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040120000443 | NY | Part B Supplier - Clinic/Group Practice | 0143121327 |
Receives reassigned benefits from 101 practitioners 1 other NPI on this enrollment Practice locations: Syracuse, NY |
| O20100129000008 | NY | Part a Provider - Federally Qualified Health Center (FQHC) | 0143121327 | Practice locations: Syracuse, NY |
National Provider Directory
Locations
710 Hawley Ave
Syracuse, NY 13203
Phone (315) 435-4097
2400 Grant Blvd
Syracuse, NY 13208
428 S Alvord St
Syracuse, NY 13208
Phone (315) 435-4210
810 Willis Ave
Syracuse, NY 13204
227 Magnolia St
Syracuse, NY 13204
930 S Salina St
Syracuse, NY 13202
Phone (315) 234-5960
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
930 S Salina St
Syracuse, NY 13202-3530
Mailing address
930 S Salina St
Syracuse, NY 13202-3530
Phone (315) 476-7921
Other practice location 1
819 S Salina St
Syracuse, NY 13202-3527
Phone (315) 476-7921
Other practice location 2
1938 E Fayette St
Syracuse, NY 13210-1339
Phone (315) 476-7921
Other practice location 3
603 Oswego St
Syracuse, NY 13204-3127
Phone (315) 476-7921
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00474204 | Medicaid | NY |
Other providers in Syracuse, NY
- Syracuse City School District
- Syracuse City School District
- Syracuse City School District
- Syracuse Community Health
- Syracuse Community Health Center
- Syracuse Community Health Center, Inc.
- Syracuse Community Health Pharmacy LLC
- Syracuse Community Health Pharmacy LLC
- Syracuse Community Pharmacy
- Syracuse Dental Associates PLLC
All providers in Syracuse, NY · Federally Qualified Health Center (FQHC) in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.