NPIMap

Organization Active NPI

Beacon Christian Community Health Center

  • Primary Care Clinic/Center
  • Staten Island, NY
National Provider Identifier
1801271911
Registry record updated Jul 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BEACON CHRISTIAN COMMUNITY HEALTH CENTER
Practice address
2079 Forest Ave
Staten Island, NY 10303-1865
Phone
(718) 815-6560
Fax
(718) 815-6576
NPI assigned
Jul 30, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2015

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

Authorized official

Name
Janet Kim, M.D., MPH, MA
Title
Chief Medical Officer
Phone
(718) 815-6560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NY Primary

Addresses

Primary practice location

2079 Forest Ave
Staten Island, NY 10303-1865

Mailing address

2079 Forest Ave
Staten Island, NY 10303-1865
Phone (718) 815-6560

Other identifiers 2

IdentifierTypeStateIssuer
133V00000XMedicaidNJ
133V00000XMedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Beacon Christian Community Health Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20119/brand/1/csg/1/fhir/r4

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1801271911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031865",
            "telephone_number": "718-815-6560",
            "fax_number": "718-815-6576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2079 FOREST AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103031865",
            "telephone_number": "718-815-6560",
            "fax_number": "718-815-6576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON CHRISTIAN COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "718-815-6560",
        "authorized_official_credential": "M.D., MPH, MA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133V00000X",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133V00000X",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.