NPIMap

Organization Active NPI

Urban Health Plan, Inc

Doing business as Peninsula Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1770847014
Registry record updated Feb 19, 2013
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
Peninsula Community Health Center
Practice address
1967 Turnbull Ave
Suite 17
Bronx, NY 10473-2519
Phone
(718) 684-3383
NPI assigned
Jul 2, 2012
Last updated
Feb 19, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
URBAN HEATLH PLAN, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 19, 2013

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

Authorized official

Name
Alexandra Borbon
Title
Dir. Credentialing
Phone
(718) 589-2440

Specialties & licenses 1

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

Addresses

Primary practice location

1967 Turnbull Ave
Suite 17
Bronx, NY 10473-2519

Mailing address

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

Other names 1

  • PENINSULA 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
O20130320000519 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 1770847014. Details of each certification follow.

Federally qualified health center certification: CCN 331057

Legal name
URBAN HEALTH PLAN INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 20, 2013
Last certification
Mar 20, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 21, 1973 in NY
Enrollment address
1967 Turnbull Ave
Bronx, NY 10473-2519

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
Marie a Belotte M D27 organizations share this tax ID, including this one
Part of
Marie a Belotte M D

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 Officer May 21, 1976
Corporate Director May 21, 1976
W-2 Managing Employee May 21, 1976
Elizabeth Alicea Individual Corporate OfficerBoard Member Sep 29, 2025
Rhynna Santos Individual Corporate DirectorChairperson of the Board Sep 26, 1971
Joan Rivera-Baker Individual Corporate DirectorSecretary of the Board Jan 1, 2009
Lorraine Marissa Gonzalez- Camastra Individual Corporate OfficerBoard Member Sep 29, 2025
Linda Baldwin Individual Corporate DirectorVice Chairperson 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 DirectorTreasurer of the Board Mar 23, 2009
Oswaldo a Guzman Individual Corporate DirectorBoard Member Jan 1, 2013
Vonetta Dudley Individual Corporate OfficerBoard Member Jun 25, 2025
Abraham Hidalgo Individual Corporate OfficerBoard Member Sep 29, 2025

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": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1770847014",
    "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": "1967 TURNBULL AVE",
            "address_2": "SUITE 17",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104732519",
            "telephone_number": "718-684-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "URBAN HEATLH PLAN, INC",
        "enumeration_date": "2012-07-02",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "BORBON",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "DIR. CREDENTIALING",
        "authorized_official_telephone_number": "718-589-2440"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PENINSULA COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.