NPIMap

Organization Active NPI

Oak Orchard Community Health Center, Inc.

Doing business as Oak Orchard Health - Hornell

  • Federally Qualified Health Center (FQHC)
  • Hornell, NY
National Provider Identifier
1548647779
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Doing business as
Oak Orchard Health - Hornell
Practice address
7309 Seneca Rd N Ste 112
Hornell, NY 14843-9691
Phone
(607) 590-2424
Fax
(607) 590-2428
NPI assigned
Apr 27, 2015
Last updated
Feb 21, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
OAK ORCHARD COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Authorized official

Name
Ms. Mary Ann Pettibon
Title
Ceo
Phone
(595) 637-3905

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7309 Seneca Rd N Ste 112
Hornell, NY 14843-9691

Mailing address

300 West Ave
Brockport, NY 14420-1118
Phone (585) 637-3905

Other names 1

  • Oak Orchard Health - Hornell Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040521001124 NY Part B Supplier - Clinic/Group Practice 5496746927 Receives reassigned benefits from 61 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hornell, NY; Warsaw, NY; Medina, NY; Lyndonville, NY; Corfu, NY; Batavia, NY; Albion, NY; Alexander, NY…
O20151228001415 NY Part A Provider - Federally Qualified Health Center (FQHC) 5496746927 Practice locations: Hornell, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548647779. Details of each certification follow.

Federally qualified health center certification: CCN 331195

Legal name
OAK ORCHARD COMMUNITY HEALTH CENTER, INC.
Doing business as
OAK ORCHARD HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2016
Last certification
Mar 29, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1973 in NY
Enrollment address
7309 Seneca Rd N
Hornell, NY 14843-9691

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Oak Orchard Community Health Center Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Chetna Chandrakala Individual Corporate OfficerCfo Mar 18, 2024
Danielle Renodin-Mead Individual W-2 Managing EmployeeMD; Jul 6, 2015
Sarah Sargent Individual W-2 Managing EmployeeController Nov 15, 2015
John Slenker Individual Other May 8, 2025
Casandra Villanueva Individual W-2 Managing EmployeeAd; Aug 27, 2024
Marco Altieri Individual Corporate Officer Jan 5, 2026
Cynda Watroba Individual Other Aug 27, 2025

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Oak Orchard Community Health Center, Inc.Albion, NY, CCN 571832 Federally qualified health center Operational/Managerial Control Mar 9, 2022

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1430092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550707200000",
    "number": "1548647779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201118",
            "telephone_number": "585-637-3905",
            "fax_number": "585-637-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7309 SENECA RD N STE 112",
            "city": "HORNELL",
            "state": "NY",
            "postal_code": "148439691",
            "telephone_number": "607-590-2424",
            "fax_number": "607-590-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK ORCHARD COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAK ORCHARD COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2015-04-27",
        "last_updated": "2019-02-21",
        "status": "A",
        "authorized_official_last_name": "PETTIBON",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "595-637-3905",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Orchard Health - Hornell",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oak Orchard Health - Hornell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hornell, NY

Sources for this page

Verify at the official NPI Registry.