NPIMap

Organization Active NPI

Open Door Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Saugerties, NY
National Provider Identifier
1780166645
Registry record updated Sep 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR FAMILY MEDICAL CENTER INC
Practice address
16 W Bridge St Ste 4
Saugerties, NY 12477
Phone
(845) 247-1030
Fax
(845) 247-1031
NPI assigned
Sep 6, 2018
Last updated
Sep 7, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
OPEN DOOR FAMILY MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2018

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

Authorized official

Name
Maria Mazzotta
Title
Cfo
Phone
(914) 941-1263

Specialties & licenses 1

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

Addresses

Primary practice location

16 W Bridge St Ste 4
Saugerties, NY 12477

Mailing address

165 Main St
Ossining, NY 10562-4702
Phone (914) 941-1263

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150224001267 NY Part B Supplier - Clinic/Group Practice 7113835380 Receives reassigned benefits from 162 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yonkers, NY; White Plains, NY; Sleepy Hollow, NY; Saugerties, NY; Port Chester, NY; Ossining, NY; Pelham, NY; Brewster, NY…
O20181220001772 NY Part A Provider - Federally Qualified Health Center (FQHC) 7113835380 Practice locations: Saugerties, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780166645. Details of each certification follow.

Federally qualified health center certification: CCN 571142

Legal name
OPEN DOOR FAMILY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 20, 2018
Last certification
Dec 20, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 2, 1975 in NY
Enrollment address
16 W Bridge St
Ste 4
Saugerties, NY 12477-1428

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
C P Lucas4 organizations share this tax ID, including this one
Part of
C P Lucas

Other organizations with this tax ID 3

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

Locations

689 Mamaroneck Ave
Mamaroneck, NY 10543
Phone (914) 253-1100

2 Wilson Pl
Fl 2
Mount Vernon, NY 10550
Phone (914) 668-9124

507 Fifth Ave
Pelham, NY 10803
Phone (914) 738-1728

1 Gateway Plz
Fl 3
Port Chester, NY 10573
Phone (914) 240-2241

16 W Bridge St
Ste 4
Saugerties, NY 12477
Phone (845) 247-1030

20 S Broadway
Yonkers, NY 10701
Phone (914) 963-9787

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
Daysi Briones Individual Corporate DirectorBoard Member May 23, 2018
Dorian Lindsay Individual Corporate DirectorBoard Member Mar 1, 2007
Daniel Ross Individual Corporate DirectorBoard Member May 25, 2016
Marie Pennaccio Individual Corporate DirectorBoard of Director May 20, 2020
Margoth Pilla Individual Corporate DirectorBoard Member May 1, 2008
William D Reifer Individual Corporate DirectorBoard of Director May 24, 2023
Maria Mazzotta Individual Corporate OfficerCfo Feb 22, 2002
W-2 Managing EmployeeCfo Oct 25, 1999
Operational/Managerial ControlCfo Feb 22, 2002
Andres Valdespino Individual Corporate DirectorBoard Member Oct 19, 2005
Lindsay C Farrell Individual Corporate OfficerPresident & Ceo Oct 1, 1998
W-2 Managing EmployeePresident & Ceo Oct 1, 1998
Operational/Managerial ControlPresident & Ceo Oct 1, 1998
Barbara Ilardi Individual Corporate DirectorBoard of Director May 23, 2018
Shirley Buontempo Individual Corporate DirectorBoard Member Jan 22, 2014
Samantha Villazan Individual Corporate DirectorBoard of Director Apr 28, 2021
Charles Chehebar Individual Corporate DirectorBoard Member May 1, 1997

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 62

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 62

NPI Registry JSON

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536278400000",
    "number": "1780166645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 MAIN ST",
            "city": "OSSINING",
            "state": "NY",
            "postal_code": "105624702",
            "telephone_number": "914-941-1263",
            "fax_number": "914-502-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 W BRIDGE ST STE 4",
            "city": "SAUGERTIES",
            "state": "NY",
            "postal_code": "12477",
            "telephone_number": "845-247-1030",
            "fax_number": "845-247-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR FAMILY MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR FAMILY MEDICAL CENTER, INC.",
        "enumeration_date": "2018-09-06",
        "last_updated": "2018-09-07",
        "status": "A",
        "authorized_official_last_name": "MAZZOTTA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "914-941-1263"
    },
    "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 Saugerties, NY

Sources for this page

Verify at the official NPI Registry.