NPIMap

Organization Active NPI

Syracuse Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Syracuse, NY
National Provider Identifier
1497796353
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

Name
Mrs. Kerri D Warner
Title
Director of Revenue Cycle Managment
Phone
(315) 476-7921

Specialties & licenses 1

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

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1497796353. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 1, 1978 in NY
Enrollment address
819 S Salina St
Syracuse, NY 13202-3527

Federally qualified health center certification: CCN 331866

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SYRACUSE COMMUNITY HEALTH CENTER EAST
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 1993
Last certification
Jun 7, 1993
Ownership / control type
For profit – partnership
Facility address
1938 East Fayette St
Syracuse, NY 13210
Related CCNs
331809

Federally qualified health center certification: CCN 331926

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SYRACUSE COMMUNITY HEALTH CENTER ONONDAGA NATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 19, 2004
Last certification
Apr 19, 2004
Ownership / control type
For profit – corporation
Facility address
603 Oswego Street
Syracuse, NY 13204
Related CCNs
331809

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1938 E Fayette St
Syracuse, NY 13210
Phone (315) 474-4077

227 Magnolia St
Syracuse, NY 13204

2400 Grant Blvd
Syracuse, NY 13208

428 S Alvord St
Syracuse, NY 13208
Phone (315) 435-4210

710 Hawley Ave
Syracuse, NY 13203
Phone (315) 435-4097

810 Willis Ave
Syracuse, NY 13204

Ownership & related parties

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.

NameRoleSinceShare
Raymond Blackwell Individual Corporate DirectorBoard Member Jan 1, 2018
Emily Demarche Individual Corporate OfficerChief Financial Officer Jan 1, 2018
Ben Moore Individual Corporate DirectorBoard Member Jan 1, 2018
Calvin Corriders Individual Corporate DirectorBoard Member Jan 1, 2018
Harry Thompson Individual Corporate DirectorBoard Member Jan 1, 2018
Stephen Markley Individual Corporate DirectorBoard Member Jan 1, 2018
Agnes McCray Individual Corporate DirectorBoard Member Jan 1, 2018
Cheryl Vitaletti Individual Corporate DirectorBoard Member Jan 1, 2018
Kevin Randall Individual Corporate DirectorBoard Member Jan 1, 2018
Vanessa Bogan Individual Corporate DirectorBoard Member Jan 1, 2018
Michael Wolfson Individual Corporate DirectorBoard Member Jan 1, 2018
W Steven Williams Individual Corporate DirectorBoard Member Jan 1, 2018
Paula Freedom Individual Corporate DirectorBoard Member Jan 1, 2018
Ofrona a Reid Individual Corporate Officer Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
Charles P Conole Individual Corporate DirectorBoard Member Jan 1, 2018
Bruce Conner Individual Corporate DirectorBoard Member Jan 1, 2018
Brian W Thompson Individual Corporate DirectorBoard Member Jan 1, 2018

Owners & managing parties with NPI records 2

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

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 151

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 151

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1497796353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S SALINA ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023530",
            "telephone_number": "315-476-7921",
            "fax_number": "315-234-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S SALINA ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132023530",
            "telephone_number": "315-476-7921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "819 S Salina St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132023527",
            "country_code": "US",
            "telephone_number": "315-476-7921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1938 E Fayette St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101339",
            "country_code": "US",
            "telephone_number": "315-476-7921",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "603 Oswego St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132043127",
            "country_code": "US",
            "telephone_number": "315-476-7921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SYRACUSE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "KERRI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE MANAGMENT",
        "authorized_official_telephone_number": "315-476-7921",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.