NPIMap

Organization Active NPI

Urban Health Plan, Inc

Doing business as Adolescent Health and Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1699072686
Registry record updated Jul 24, 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
Adolescent Health and Wellness Center
Practice address
960 Southern Blvd
Bronx, NY 10459-3402
Phone
(718) 589-2440
Fax
(718) 991-4516
NPI assigned
Feb 28, 2011
Last updated
Jul 24, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
ADOLESCENT HEALTH AND WELLNESS CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 24, 2012

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

Authorized official

Name
Dr. Samuel Deleon Jr., M.D.
Title
VP Medical Affairs/Cmo
Phone
(718) 589-2440

Specialties & licenses 1

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

Addresses

Primary practice location

960 Southern Blvd
Bronx, NY 10459-3402

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
331015OtherNYSITE MEDICARE ID #
02994952MedicaidNY

Other names 1

  • ADOLESCENT HEALTH AND WELLNESS CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110323000002 NY Part A Provider - Federally Qualified Health Center (FQHC) 3173517281 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699072686. Details of each certification follow.

Federally qualified health center certification: CCN 331015

Legal name
URBAN HEALTH PLAN INC
Doing business as
ADOLESCENT HEALTH AND WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2011
Last certification
May 13, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1973 in NY
Enrollment address
960 Southern Blvd
Bronx, NY 10459-3402
Related CCNs
331885

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

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
Nelson J Alvarez27 organizations share this tax ID, including this one
Part of
Nelson J Alvarez

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 13

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

NameRoleSinceShare
Frank Estrada Individual Corporate DirectorBoard Member Mar 23, 2009
Paloma Hernandez Individual Corporate OfficerPresident and Ceo Jun 21, 1974
Corporate DirectorPresident and Ceo Jun 21, 1974
Operational/Managerial ControlPresident and Ceo Jun 21, 1974
Heroilda Vega Individual Corporate DirectorBoard Member Jan 1, 1990
Rhynna Santos Individual Corporate DirectorBoard Member Sep 26, 2019
Joan Rivera-Baker Individual Corporate DirectorBoard Member Jan 1, 2009
Linda Baldwin Individual Corporate DirectorBoard Member Mar 23, 2009
Charles Gonzalez Individual Corporate DirectorBoard Member Jan 1, 1990
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
Michelle Carr Individual Corporate DirectorBoard Member / Secretary Jan 1, 2001
Yoselin Genao Individual Corporate DirectorBoard Member Nov 15, 2016

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343088000000",
    "number": "1699072686",
    "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": "960 SOUTHERN BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104593402",
            "telephone_number": "718-589-2440",
            "fax_number": "718-991-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADOLESCENT HEALTH AND WELLNESS CENTER",
        "enumeration_date": "2011-02-28",
        "last_updated": "2012-07-24",
        "status": "A",
        "authorized_official_last_name": "DELEON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP MEDICAL AFFAIRS/CMO",
        "authorized_official_telephone_number": "718-589-2440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SITE MEDICARE ID #",
            "identifier": "331015",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02994952",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADOLESCENT HEALTH AND WELLNESS CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.