NPIMap

Organization Active NPI

Whitney M. Young, Jr. Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, NY
National Provider Identifier
1710623913
Registry record updated May 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Practice address
526 Central Ave
Albany, NY 12206-2359
Phone
(518) 465-4771
NPI assigned
May 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2022

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

Authorized official

Name
David Harold Shippee
Title
President/Ceo
Phone
(518) 591-4459

Specialties & licenses 1

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

Addresses

Primary practice location

526 Central Ave
Albany, NY 12206-2359

Mailing address

920 Lark Dr
Albany, NY 12207-1300

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040821000073 NY Part B Supplier - Clinic/Group Practice 6507830031 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albany, NY; Troy, NY; Watervliet, NY
O20220811002590 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY

Federally qualified health center certification: CCN 571838

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2022
Last certification
Aug 6, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 5, 1974 in NY
Enrollment address
526 Central Avenue
Ste 101
Albany, NY 12206-2359

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 5

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
33D2256195Whitney M Young Jr Health Center-Swinburne526 Central Ave, Albany, NY 12206Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Whitney M Young Troy Health15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

920 Lark Dr
Albany, NY 12207
Phone (518) 427-0102

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Gus Birkhead Individual Corporate DirectorBoard Member Apr 12, 2022
Casey Parker Individual Corporate DirectorBoard Member Apr 6, 2021
Charles Welge Individual Corporate DirectorBoard Member Apr 9, 2024
David Harold Shippee Individual Corporate OfficerCeo/President Apr 28, 2011
W-2 Managing EmployeeCeo/President Apr 28, 2011
Marlowe Cochran Individual Corporate DirectorBoard Member Apr 5, 2016
Rosalyn Duvall Individual Corporate DirectorBoard Member Apr 11, 2023
Gary Guy Individual Corporate DirectorBoard Member Apr 11, 2023
Annette Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Susanne M Isabella Individual Corporate DirectorRevenue Cycle Director Jul 23, 2021
W-2 Managing EmployeeRevenue Cycle Director Jul 23, 2021
Ceylon Moore Individual Corporate DirectorBoard Member Jun 6, 2016
Tracey Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
John E Fraher Individual Corporate OfficerCfo Nov 19, 2018
W-2 Managing EmployeeCfo Nov 19, 2018
Kelli Arnold Individual Corporate DirectorBoard Member May 14, 2024
Lauri Rosmarin-Plattner Individual Corporate DirectorBoard Member Apr 11, 2023

Practitioners & affiliated clinicians

Practitioners 1

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": "1652140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652140800000",
    "number": "1710623913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 CENTRAL AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122062359",
            "telephone_number": "518-465-4771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-10",
        "last_updated": "2022-05-10",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "SHIPPEE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "518-591-4459"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.