NPIMap

Organization Active NPI

Urban Health Plan, Inc.

Doing business as Plaza del Sol Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Corona, NY
National Provider Identifier
1710125141
Registry record updated Feb 28, 2011
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
Plaza del Sol Family Health Center
Practice address
3716 108TH St
Corona, NY 11368-2025
Phone
(718) 651-4000
Fax
(718) 991-4516
NPI assigned
Jan 22, 2009
Last updated
Feb 28, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PLAZA DEL SOL FAMILY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

3716 108TH St
Corona, NY 11368-2025

Mailing address

3716 108TH St
Corona, NY 11368-2025
Phone (718) 651-4000

Other identifiers 1

IdentifierTypeStateIssuer
00244977MedicaidNY

Other names 1

  • PLAZA DEL SOL FAMILY 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
O20040412001518 NY Part B Supplier - Clinic/Group Practice 3173517281 Receives reassigned benefits from 273 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY; Corona, NY; Elmhurst, NY; New York, NY
O20090313000200 NY Part A Provider - Federally Qualified Health Center (FQHC) 3173517281 Practice locations: Corona, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710125141. Details of each certification follow.

Federally qualified health center certification: CCN 331002

Legal name
URBAN HEALTH PLAN INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 29, 2009
Last certification
Apr 29, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1973 in NY
Enrollment address
3712 108TH St
Corona, NY 11368-2025

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Nelson J Alvarez

Locations

3716 108th St
Corona, NY 11368
Phone (718) 651-4000

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/Ceo Jun 21, 1973
Corporate DirectorPresident/Ceo Jun 21, 1973
Operational/Managerial ControlPresident/Ceo Jun 21, 1973
Heroilda Vega Individual Corporate DirectorBoard Member Mar 23, 2009
Rhynna Santos Individual Corporate DirectorBoard Member Sep 26, 2019
Joan Rivera-Baker Individual Corporate DirectorBoard Member Mar 23, 2009
Linda Baldwin Individual Corporate DirectorBoard Member Mar 23, 2009
Charles Gonzalez Individual Corporate DirectorBoard Member Mar 23, 2009
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 Mar 23, 2009
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.

Practitioners & affiliated clinicians

Practitioners 111

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.

View all 111

NPI Registry JSON

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298851200000",
    "number": "1710125141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682025",
            "telephone_number": "718-651-4000",
            "fax_number": "718-991-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3716 108TH ST",
            "city": "CORONA",
            "state": "NY",
            "postal_code": "113682025",
            "telephone_number": "718-651-4000",
            "fax_number": "718-991-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLAZA DEL SOL FAMILY HEALTH CENTER",
        "enumeration_date": "2009-01-22",
        "last_updated": "2011-02-28",
        "status": "A",
        "authorized_official_last_name": "DELEON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CMO/VP MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "718-589-2440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244977",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PLAZA DEL SOL FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Corona, NY

Sources for this page

Verify at the official NPI Registry.