NPIMap

Organization Active NPI

Northern Oswego County Health Services, Inc.

  • Community Health Clinic/Center
  • Pulaski, NY
National Provider Identifier
1669873071
Registry record updated Sep 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Practice address
4624 Salina St
Pulaski, NY 13142-2102
Phone
(315) 298-2696
Fax
(315) 298-7831
NPI assigned
Sep 5, 2014
Last updated
Sep 5, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 5, 2014

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

Authorized official

Name
Karen Paterniti
Title
Chief Financial Officer
Phone
(315) 298-6569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4624 Salina St
Pulaski, NY 13142-2102

Mailing address

4624 Salina St
Pulaski, NY 13142-2102
Phone (315) 298-2696

Other names 1

  • Health Center at Pulaski Jr./Sr. High Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150310000237 NY Part A Provider - Federally Qualified Health Center (FQHC) 8426961541 Practice locations: Pulaski, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669873071. Details of each certification follow.

Federally qualified health center certification: CCN 331144

Legal name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2015
Last certification
Mar 10, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1969 in NY
Enrollment address
4624 Salina St
Pulaski Jr/Sr. High School
Pulaski, NY 13142-2102

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
N Oswego County Health17 organizations share this tax ID, including this one
Part of
N Oswego County Health

Other organizations with this tax ID 16

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

View all 16

Locations

639 County Route 22
Parish, NY 13131
Phone (315) 625-5213

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
Tracy Wimmer Individual Corporate OfficerVice President Cfo Jul 1, 2018 5%
W-2 Managing Employee Mar 7, 2016
Judith Catella Individual Corporate Director Apr 1, 1988
David Dingman Individual Corporate Director Apr 1, 2019
Steven Gaffney Individual Corporate Officer Apr 1, 2020
Tricia Peter Clark Individual Corporate OfficerPresident Ceo Jun 4, 2021 5%
W-2 Managing Employee Jul 26, 2004
Michael Backus Individual Corporate Officer Apr 1, 2015
Robert Trainham Individual Corporate Director Apr 1, 2015
Timothy McCluskey Individual Corporate OfficerPresident Apr 1, 2007
Felicity Hallanan Individual Corporate Director Jun 1, 2007
Kathleen McLeod Individual Corporate Director Jan 2, 2007
James Oldenburg Individual Corporate Director Apr 1, 2018
Susan Lobdell Individual Corporate Director Apr 1, 2018
Micheal D Stephens Individual Corporate Director Apr 1, 2020
Robert Oustrich Individual Corporate Director Apr 1, 2017
Northern Oswego County Health Services, Inc. Organization, Pulaski, NY Non-profit Operational/Managerial Control Feb 28, 2004 100%
Lauren Seiter Individual Corporate Director Apr 1, 2016
Rose Ann Jerrett Individual Corporate Director Apr 1, 2016

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Northern Oswego County Health Services, Inc.Phoenix, NY, CCN 331135 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331133 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Mexico, NY, CCN 331132 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331139 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2012
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331140 Federally qualified health center Operational/Managerial Control (100%) Jan 20, 2008
Northern Oswego County Health Services, Inc.Mexico, NY, CCN 331142 Federally qualified health center Operational/Managerial Control (100%) Jan 24, 2014
Northern Oswego County Health Services, Inc.Pulaski, NY, CCN 331141 Federally qualified health center Operational/Managerial Control (100%) Feb 28, 2004

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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": "1409875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409875200000",
    "number": "1669873071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 SALINA ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131422102",
            "telephone_number": "315-298-2696",
            "fax_number": "315-298-7831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 SALINA ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131422102",
            "telephone_number": "315-298-2696",
            "fax_number": "315-298-7831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.",
        "enumeration_date": "2014-09-05",
        "last_updated": "2014-09-05",
        "status": "A",
        "authorized_official_last_name": "PATERNITI",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "315-298-6569"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center at Pulaski Jr./Sr. High",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pulaski, NY

Sources for this page

Verify at the official NPI Registry.