NPIMap

Organization Active NPI

Family Health Network of Central New York, Inc.

Doing business as Family Health Network Mobile Van

  • Federally Qualified Health Center (FQHC)
  • Homer, NY
National Provider Identifier
1780633982
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Doing business as
Family Health Network Mobile Van
Practice address
85 S West St
Homer, NY 13077-1542
Phone
(607) 753-3797
Fax
(607) 753-6677
NPI assigned
May 8, 2006
Last updated
Oct 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Kimberly Osborne
Title
Ceo
Phone
(607) 753-3797

Specialties & licenses 1

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

Addresses

Primary practice location

85 S West St
Homer, NY 13077-1542

Mailing address

85 S West St
Homer, NY 13077-1542
Phone (607) 753-3797

Other names 1

  • Family Health Network Mobile Van Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221115003164 NY Part A Provider - Federally Qualified Health Center (FQHC) 2668385014 Practice locations: Homer, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780633982. Details of each certification follow.

Federally qualified health center certification: CCN 571844

Legal name
FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.
Doing business as
FAMILY HEALTH NETWORK MOBILE VAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 10, 2022
Last certification
Nov 10, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 2, 1989 in NY
Enrollment address
85 S West St
Homer, NY 13077-1542

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Martin Fejka8 organizations share this tax ID, including this one
Part of
Martin Fejka

Other organizations with this tax ID 7

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

Locations

24 Groton Ave
Cortland, NY 13045
Phone (607) 753-3774

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Kimberly Osborne Individual Corporate DirectorPresident/Ceo Sep 21, 2019 100%
W-2 Managing EmployeePresident/Ceo Sep 21, 2019
John Robert Hughes Individual Corporate DirectorBoard President Sep 18, 2019
Diane Wheaton Individual Corporate DirectorBoard Member Feb 23, 2012
Tara Larrabee Individual Corporate DirectorBoard Member Oct 31, 2018
Charles Sherman Individual Corporate DirectorBoard Treasurer Jun 12, 2009
Elaine Lambert Individual Corporate DirectorBoard Member Aug 10, 2022
Greg Richards Individual Corporate DirectorBoard Member Jun 28, 2017
Shirley Garcia Individual Corporate DirectorBoard Member Jun 28, 2017
Thomas Tylutki Individual Corporate DirectorBoard Member Mar 11, 2020
Kimberly Sharpe Individual Corporate DirectorBoard Member Jun 14, 2023
Jeanette Dippo Individual Corporate DirectorBoard Secretary Jun 28, 2017

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 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1780633982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 S WEST ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771542",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 S WEST ST",
            "city": "HOMER",
            "state": "NY",
            "postal_code": "130771542",
            "telephone_number": "607-753-3797",
            "fax_number": "607-753-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC.",
        "enumeration_date": "2006-05-08",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "OSBORNE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "607-753-3797"
    },
    "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": "Family Health Network Mobile Van",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Homer, NY

Sources for this page

Verify at the official NPI Registry.