NPIMap

Organization Active NPI

Bronxcare Health System

Doing business as BronxCare Health & Wellness

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1831515154
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
7000001H Issued in NY
Legal business name
BRONXCARE HEALTH SYSTEM
Doing business as
BronxCare Health & Wellness
Practice address
199 Mount Eden Pkwy
Bronx, NY 10457
Phone
(718) 901-8600
Fax
(718) 293-1475
NPI assigned
Mar 11, 2014
Last updated
Feb 6, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BRONXCARE HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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

Authorized official

Name
Mr. Victor George Demarco
Title
SVP/Cfo
Phone
(718) 901-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 7000001H NY Primary

Addresses

Primary practice location

199 Mount Eden Pkwy
Bronx, NY 10457

Mailing address

1276 Fulton Ave FL 3
Bronx, NY 10456-3402
Phone (718) 901-8600

Other names 1

  • BronxCare Health & Wellness Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140331001577 NY Part A Provider - Federally Qualified Health Center (FQHC) 3870404429 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831515154. Details of each certification follow.

Federally qualified health center certification: CCN 331113

Legal name
BRONXCARE HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 21, 2014
Last certification
Apr 21, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 26, 1962 in NY
Enrollment address
199 Mount Eden Pkwy
Bronx, NY 10457-7703

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
BLHC OB GYN Group28 organizations share this tax ID, including this one
Part of
BLHC OB GYN Group

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Dormitory Authority of the State of New York Organization, Albany, NY Created for acquisition 5% Or Greater Mortgage Interest Jan 18, 2007
David Gomez Individual Corporate DirectorBoard Member Jul 13, 2021
Barbara a Lowe Individual Corporate DirectorBoard Member Oct 10, 2000
Steven Landgraber Individual Corporate DirectorBoard Member Jul 13, 2021
TD Bank N.a. Organization, Wilmington, DE Created for acquisition, Financial institution 5% Or Greater Mortgage Interest Feb 26, 2009
John R Colon Individual Corporate DirectorBoard Member Jan 9, 2007
Milagros Baez O'Toole Individual Corporate DirectorBoard Member Jan 1, 2013
Octavio Marin Individual W-2 Managing EmployeeVice President Jul 10, 2006
Miguel Fuentes Individual Corporate OfficerPresident May 8, 1987
Corporate DirectorBoard Member May 6, 1987
William Aguado Individual Corporate DirectorBoard Member Jul 13, 2021
Cristina Toosie Individual Corporate DirectorBoard Member Jan 9, 1990
Victor G Demarco Individual Corporate OfficerSenior Vice President Nov 1, 1999
W-2 Managing EmployeeCfo Nov 1, 1999
Ricardo R. Fernandez Individual Corporate DirectorBoard Member May 12, 1992
Rita Dimartino Individual Corporate DirectorBoard Member Sep 15, 1987

NPI Registry JSON

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

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1831515154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE FL 3",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 MOUNT EDEN PKWY",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10457",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONXCARE HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONXCARE HEALTH SYSTEM",
        "enumeration_date": "2014-03-11",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A",
        "authorized_official_last_name": "DEMARCO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "718-901-8600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7000001H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BronxCare Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.