NPIMap

Organization Active NPI

Boston Health Care for the Homeless Program, Inc.

  • Federally Qualified Health Center (FQHC)
  • Roxbury, MA
National Provider Identifier
1750958807
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.
Practice address
1785 Columbus Ave
Roxbury, MA 02119-1041
Phone
(857) 654-1227
NPI assigned
Jun 8, 2021
Last updated
Jun 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Authorized official

Name
Agnes W Leung
Title
Chief Financial Officer
Phone
(857) 654-1200

Specialties & licenses 1

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

Addresses

Primary practice location

1785 Columbus Ave
Roxbury, MA 02119-1041

Mailing address

780 Albany St
Boston, MA 02118-2755
Phone (857) 654-1227

Other names 1

  • BHCHP Family Care Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110527000309 MA Part B Supplier - Clinic/Group Practice 2668475419 Receives reassigned benefits from 139 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Roxbury, MA; Quincy, MA; Jamaica Plain, MA; Boston, MA
O20220202001645 MA Part A Provider - Federally Qualified Health Center (FQHC) 2668475419 Practice locations: Roxbury, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750958807. Details of each certification follow.

Federally qualified health center certification: CCN 221958

Legal name
BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.
Doing business as
MCINNIS HEALTH GROUP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2022
Last certification
Feb 2, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1992 in MA
Enrollment address
1785 Columbus Ave
Ste 200
Roxbury, MA 21191041

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Boston Health Care for the Homeless Program Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1785 Columbus Ave
Roxbury, MA 02119
Phone (617) 989-2922

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Steve Tringale Individual Corporate DirectorTreasurer Jul 8, 1997
Deion Scott Hawkins Individual Corporate DirectorBoard Member Jul 11, 2023 5%
Sara Gaia Reid Individual Corporate DirectorBoard Member May 12, 2015
Derek Winbush Individual Corporate DirectorBoard Member Jul 13, 2010
Paul Jeremiah Selian Individual Corporate DirectorBoard Member Jul 11, 2023 5%
Alice Kenney Walsh Individual Corporate DirectorBoard Member Jan 13, 2026 5%
Brett Painchaud Individual Corporate DirectorChair Jul 8, 2008
Denise de Las Nueces Individual Corporate OfficerCeo Apr 14, 2026
W-2 Managing Employee Jul 9, 2012
Joanne M Guarino Individual Corporate DirectorBoard Member Jun 12, 2012
Steven Myles Walsh Individual Corporate DirectorBoard Member Jan 12, 2016
Thomas Dehner Individual Corporate DirectorBoard Member Aug 9, 2011
Barbara Blakeney Individual Corporate DirectorVice Chair Jul 14, 2009
Francis Hyatt Individual Corporate Director Nov 12, 2019
Agnes Leung Individual Corporate OfficerCfo Aug 8, 2006
W-2 Managing Employee Aug 8, 2006
Ryan William O'Donnell Individual Corporate DirectorBoard Member Aug 14, 2018
Valeria Anita Ramdin Individual Corporate DirectorBoard Member Jul 12, 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 9

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": "1623110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623110400000",
    "number": "1750958807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 ALBANY ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182755",
            "telephone_number": "857-654-1227",
            "fax_number": "857-654-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 COLUMBUS AVE",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191041",
            "telephone_number": "857-654-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON HEALTH CARE FOR THE HOMELESS PROGRAM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A",
        "authorized_official_last_name": "LEUNG",
        "authorized_official_first_name": "AGNES",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "857-654-1200"
    },
    "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": "BHCHP Family Care Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roxbury, MA

Sources for this page

Verify at the official NPI Registry.