NPIMap

Organization Active NPI

Senior Whole Health of New York, Inc

  • Health Maintenance Organization
  • New York, NY
National Provider Identifier
1548677883
Registry record updated Jul 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SENIOR WHOLE HEALTH OF NEW YORK, INC
Practice address
111 Broadway RM 1505
New York, NY 10006-1926
Phone
(617) 494-5353
NPI assigned
Jul 18, 2014
Last updated
Jul 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2014

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

Authorized official

Name
Mr. Thurman Justice
Title
Cfo
Phone
(617) 494-5353

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

111 Broadway RM 1505
New York, NY 10006-1926

Mailing address

58 Charles St
Cambridge, MA 02141-2128
Phone (617) 494-5353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220921002638 NY Part B Supplier - Clinic/Group Practice 8628453016 Receives reassigned benefits from 23 practitioners
Practice locations: Bronx, NY; Brooklyn, NY

National Provider Directory

National Provider Directory

Locations

58 Charles St
Cambridge, MA 02141
Phone (617) 252-6324

15 Metrotech Ctr
Fl 11
Brooklyn, NY 11201
Phone (718) 923-7100

111 Broadway
Rm 1505
New York, NY 10006
Phone (617) 494-5353

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1405641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405641600000",
    "number": "1548677883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 CHARLES ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021412128",
            "telephone_number": "617-494-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BROADWAY RM 1505",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061926",
            "telephone_number": "617-494-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR WHOLE HEALTH OF NEW YORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-18",
        "last_updated": "2014-07-18",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "THURMAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "617-494-5353",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.