NPIMap

Organization Active NPI

Jericho Road Ministries, Inc.

Doing business as Jericho Road Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Buffalo, NY
National Provider Identifier
1619307022
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JERICHO ROAD MINISTRIES, INC.
Doing business as
Jericho Road Community Health Center
Practice address
21 Doat Street
Buffalo, NY 14211-1612
Phone
(716) 892-2775
Fax
(716) 597-0554
NPI assigned
Nov 21, 2013
Last updated
Sep 9, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
JERICHO ROAD MINISTRIES INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Authorized official

Name
Jackie Endress
Title
Credentialing Specialist
Phone
(716) 348-3000

Specialties & licenses 1

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

Addresses

Primary practice location

21 Doat Street
Buffalo, NY 14211-1612

Mailing address

21 Doat Street
Buffalo, NY 14211-1616
Phone (716) 892-2775

Other practice location 1

1609 Genesee St
Buffalo, NY 14211-1616
Phone (716) 892-2775

Other practice location 2

19 Doat St
Buffalo, NY 14211-1612
Phone (716) 892-2775

Other names 1

  • Jericho Road Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20131211000108 NY Part A Provider - Federally Qualified Health Center (FQHC) 5597992933 Practice locations: Buffalo, NY
O20150116000533 NY Part B Supplier - Clinic/Group Practice 5597992933 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Buffalo, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619307022. Details of each certification follow.

Federally qualified health center certification: CCN 331089

Legal name
JERICHO ROAD MINISTRIES, INC.
Doing business as
JERICHO ROAD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 16, 2014
Last certification
Jan 16, 2014
Ownership / control type
For profit – corporation
Organization structure
LLCNon-profit
Incorporated
Jan 31, 2003 in NY
Enrollment address
21 Doat St
Buffalo, NY 14211-1612

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2193165Jericho Road Community Health Center21 Doat St, Buffalo, NY 14211Provider-performed microscopyMar 26, 2027

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 disclosed owners & managing parties 21

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

NameRoleSinceShare
Donna Darrell Individual Corporate OfficerBoard Member Feb 1, 2011
Katie Badeau Individual Corporate DirectorBoard Member Sep 25, 2025
Maggie Nichols Individual Corporate OfficerChief Operations Officer Apr 15, 2024
W-2 Managing Employee Dec 1, 2023
Myron L Glick Individual W-2 Managing EmployeeMedical Doctor Jul 1, 2019
Martha Burt Individual Corporate DirectorBoard Member Jun 27, 2024
Fidele Menavanza Individual Corporate OfficerChief Compliance Officer Feb 28, 2022
Adoni Nyamuke Individual Corporate OfficerBoard Member Mar 24, 2022
John Hurley Individual Corporate DirectorBoard Member Jun 27, 2024
Luther K Robinson Individual Corporate DirectorBoard Member Oct 31, 2024
Paul Harris Individual Corporate OfficerBoard Member Aug 26, 2021
Chris Jhu Individual Corporate DirectorBoard Member Dec 19, 2024
John Lee Individual Corporate OfficerBoard Member, Board Vice Preside Dec 10, 2010
David Holmes Individual Corporate OfficerBoard Member Dec 1, 2010
Faustina Palmatier Individual Corporate DirectorBoard Member Sep 26, 2024
Lawaye Htoo Individual Corporate OfficerBoard Member Sep 10, 2015
Mark Herskind Individual Corporate OfficerBoard Member, Board Treasurer Feb 1, 2006
Connie Jozwiak-Fields Individual Corporate OfficerBoard Member Aug 1, 2009
Seraphine Sargent Individual Corporate DirectorBoard Member Nov 19, 2024
Allana Marie Krolikowski Individual Corporate OfficerChief Executive Officer Jul 1, 2019
W-2 Managing EmployeeC.E.O. Oct 4, 2025
Veronica Koller Individual Corporate DirectorBoard Member Jul 8, 2024
Jill Meyer Individual Corporate OfficerBoard Member, Board Secretary Feb 1, 2006

Owners & managing parties with NPI records 3

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
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.

Practitioners & affiliated clinicians

Practitioners 4

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": "1384992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1619307022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 DOAT STREET",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142111616",
            "telephone_number": "716-892-2775",
            "fax_number": "716-597-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 DOAT STREET",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142111612",
            "telephone_number": "716-892-2775",
            "fax_number": "716-597-0554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1609 Genesee St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142111616",
            "country_code": "US",
            "telephone_number": "716-892-2775",
            "fax_number": "716-597-0554",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19 Doat St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142111612",
            "country_code": "US",
            "telephone_number": "716-892-2775",
            "fax_number": "716-597-0554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JERICHO ROAD MINISTRIES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JERICHO ROAD MINISTRIES INC.",
        "enumeration_date": "2013-11-21",
        "last_updated": "2021-09-09",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "ENDRESS",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "716-348-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jericho Road Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jericho Road Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.