NPIMap

Organization Active NPI

Urban Health Plan, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1689910622
Registry record updated Dec 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
URBAN HEALTH PLAN, INC.
Doing business as
Saint Lawrence Community Health Center
Practice address
1764 Westchester Ave
Bronx, NY 10472-3022
Phone
(718) 589-2440
NPI assigned
Dec 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2012

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

Authorized official

Name
Dr. Samuel A Deleon Jr., MD
Title
Chief Medical Officer
Phone
(718) 589-2440

Specialties & licenses 1

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

Addresses

Primary practice location

1764 Westchester Ave
Bronx, NY 10472-3022

Mailing address

1065 Southern Blvd
Bronx, NY 10459-2417
Phone (718) 589-2440

Other names 1

  • Saint Lawrence Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130828000618 NY Part A Provider - Federally Qualified Health Center (FQHC) 3173517281 Practice locations: Bronx, NY

Federally qualified health center certification: CCN 331077

Legal name
URBAN HEALTH PLAN INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 28, 2013
Last certification
Aug 28, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1973 in NY
Enrollment address
1764 Westchester Avenue
Bronx, NY 10472-3022

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Urban Health Plan Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Paloma Hernandez Individual Corporate OfficerPresident and Ceo Jun 21, 1973
Corporate DirectorPresident and Ceo Jun 21, 1973
W-2 Managing EmployeePresident and Ceo Jun 21, 1973
Janette Stanford Individual Corporate DirectorBoard Member Jan 1, 2023
Rhynna Santos Individual Corporate DirectorBoard Member Sep 26, 2019
Joan Rivera-Baker Individual Corporate DirectorBoard Member/Secretary Jan 1, 2009
Linda Baldwin Individual Corporate DirectorBoard Member Jun 15, 1998
Charles Gonzalez Individual Corporate DirectorBoard Member Jun 15, 1998
Edward S Butts Individual Corporate DirectorBoard Member Jan 1, 2011
Clifford Charles Individual Corporate DirectorBoard Member/Treasurer Mar 23, 2009
Oswaldo a Guzman Individual Corporate DirectorBoard Member Jan 1, 2013
Howard Hinestroza Individual Corporate DirectorBoard Member Oct 27, 2016
Yoselin Genao Individual Corporate DirectorBoard Member Nov 15, 2016
Robert C Alvis Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1689910622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104592417",
            "telephone_number": "718-589-2440",
            "fax_number": "718-991-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1764 WESTCHESTER AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104723022",
            "telephone_number": "718-589-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "DELEON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "718-589-2440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "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": "Saint Lawrence Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.