NPIMap

Organization Active NPI

Jericho Road Ministries, Inc.

  • Community/Retail Pharmacy
  • Buffalo, NY
National Provider Identifier
1548825482
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
JERICHO ROAD MINISTRIES, INC.
Practice address
1021 Broadway Street
Buffalo, NY 14212-1460
Phone
(716) 529-3029
NPI assigned
May 7, 2019
Organization subpart
Yes
Parent organization
JERICHO ROAD MINISTRIES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
Karen Dann
Title
Chief of Ancillary Services
Phone
(716) 573-5382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1021 Broadway Street
Buffalo, NY 14212-1460

Mailing address

1021 Broadway St
Buffalo, NY 14212-1460
Phone (716) 529-3029

Other identifiers 1

IdentifierTypeStateIssuer
06080120MedicaidNY

Other names 1

  • JRCHC PHARMACY @ BROADWAY Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191118002188 NY Part B Supplier - Pharmacy 5597992933 Practice locations: Buffalo, NY
O20220727002107 NY DME Supplier - Pharmacy 5597992933 Practice locations: Buffalo, NY

Other NPIs with the same Medicare PAC ID 6

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Jericho Road Ministries, Inc.1021 Broadway St, Buffalo, NY 14212-14607165293029550 Immunosuppressive Drugs|Nebulizer Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Enteral Nutrients Accepts assignmentParticipating since Dec 20, 2021

National Provider Directory

National Provider Directory
Tax ID family
Jericho Road Ministries Inc7 organizations share this tax ID, including this one
Part of
Jericho Road Ministries Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Jericho Road Community Health Center Vive ClinicBuffalo, NY, CCN 571918 Federally qualified health center Operational/Managerial Control Jul 1, 2025

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1548825482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 BROADWAY ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142121460",
            "telephone_number": "716-529-3029",
            "fax_number": "716-529-3049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 BROADWAY STREET",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142121460",
            "telephone_number": "716-529-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERICHO ROAD MINISTRIES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JERICHO ROAD MINISTRIES, INC.",
        "enumeration_date": "2019-05-07",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "DANN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CHIEF OF ANCILLARY SERVICES",
        "authorized_official_telephone_number": "716-573-5382"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06080120",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JRCHC PHARMACY @ BROADWAY",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "JRCHC PHARMACY @ BROADWAY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.