NPIMap

Organization Active NPI

Urban Health Plan, Inc

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1831497130
Registry record updated Mar 17, 2011
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
Practice address
1290 Spofford Ave
Bronx, NY 10474-6511
Phone
(718) 589-2440
NPI assigned
Mar 10, 2011
Organization subpart
Yes
Parent organization
PS 48 - SCHOOL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2011

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

Authorized official

Name
Dr. Samuel Deleon Jr., MD
Title
VP/Cmo Medical Affairs
Phone
(718) 589-2440

Specialties & licenses 1

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

Addresses

Primary practice location

1290 Spofford Ave
Bronx, NY 10474-6511

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
02994952MedicaidNY

Other names 1

  • PS 48 - SCHOOL HEALTH Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140206000503 NY Part A Provider - Federally Qualified Health Center (FQHC) 3173517281 Practice locations: Bronx, NY

Federally qualified health center certification: CCN 331095

Legal name
URBAN HEALTH PLAN INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2014
Last certification
Feb 11, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 21, 1973 in NY
Enrollment address
1290 Spofford Ave
Bronx, NY 10474-6511

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
Urban Health Plan Inc27 organizations share this tax ID, including this one
Part of
Urban Health Plan Inc

Other organizations with this tax ID 26

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

View all 26

Locations

1290 Spofford Ave
Bronx, NY 10474
Phone (347) 503-7935

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 OfficerPresident and Ceo Jun 21, 1976
Corporate DirectorPresident and Ceo Jun 21, 1976
Operational/Managerial ControlPresident and Ceo Jun 21, 1976
Janette Stanford Individual Corporate DirectorBoard Member Jan 1, 2023
Rhynna Santos Individual Corporate DirectorBoard Member Sep 26, 2023
Joan Rivera-Baker Individual Corporate DirectorBoard Member/Secretary Jan 1, 2009
Linda Baldwin Individual Corporate DirectorBoard Member Mar 23, 2003
Charles Gonzalez Individual Corporate DirectorBoard Member Jan 1, 1990
Edward S Butts Individual Corporate DirectorBoard Member/ Secretary Jan 1, 2011
Clifford Charles Individual Corporate DirectorBoard Member/ Treasurer Mar 23, 2009
Oswaldo a Guzman Individual Corporate DirectorBoard Member Jan 1, 2013
Howard Hinestroza Individual Corporate DirectorBoard Member Oct 27, 2016
Yoselin Genao Individual Corporate DirectorBoard Member Nov 15, 2016
Robert C Alvis Individual Corporate DirectorBoard Member Jan 1, 2023

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 158

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 158

NPI Registry JSON

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1831497130",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 SPOFFORD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104746511",
            "telephone_number": "718-589-2440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN HEALTH PLAN, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PS 48 - SCHOOL HEALTH",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "DELEON",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP/CMO MEDICAL AFFAIRS",
        "authorized_official_telephone_number": "718-589-2440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02994952",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PS 48 - SCHOOL HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.