NPIMap

Organization Active NPI

Cornerstone Family Healthcare

  • Federally Qualified Health Center (FQHC)
  • Middletown, NY
National Provider Identifier
1841813623
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CORNERSTONE FAMILY HEALTHCARE
Practice address
10 Benton Ave
Middletown, NY 10940-5177
Phone
(845) 563-8000
NPI assigned
May 27, 2020
Organization subpart
Yes
Parent organization
CORNERSTONE FAMILY HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Authorized official

Name
David Jolly
Title
Ceo
Phone
(845) 220-3165

Specialties & licenses 1

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

Addresses

Primary practice location

10 Benton Ave
Middletown, NY 10940-5177

Mailing address

2570 Route 9W Ste 10
Cornwall, NY 12518-1370
Phone (845) 220-3100

Other names 1

  • The Greater Hudson Valley Family Health Center, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180227001025 NY Part A Provider - Federally Qualified Health Center (FQHC) 4880610393 1 other NPI on this enrollment
Practice locations: Middletown, NY

Federally qualified health center certification: CCN 571091

Legal name
CORNERSTONE FAMILY HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 6, 2018
Last certification
Mar 6, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 6, 1981 in NY
Enrollment address
10 Benton Ave
Middletown, NY 10940-5177

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2141823Cornerstone Family Healthcare10 Benton Ave, Middletown, NY 10940Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Nancy a Benjamin14 organizations share this tax ID, including this one
Part of
Nancy a Benjamin

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Gopal Bhalla Individual Corporate DirectorBoard Member Aug 22, 2023
Michele McKeon Individual Corporate DirectorBoard Member Apr 26, 2022
Nelson McAllister Individual Corporate DirectorBoard Member Jan 1, 2002
Andrew Bell Individual Corporate DirectorBoard Member Apr 27, 2021
Wayne Day Individual Corporate DirectorBoard Member Jan 1, 2008
Debra Johnson Individual Corporate DirectorBoard Member Jan 1, 2008
Jason T Giordano Individual Corporate DirectorBoard Member Jul 26, 2022
Rhonda Green Individual Corporate DirectorBoard Member Apr 1, 2019
Charles a Walwyn Individual Corporate DirectorBoard Member Apr 25, 2017
Daisy Vale Individual Corporate DirectorBoard Member Apr 1, 2007
Cheryl Ross Individual Corporate DirectorBoard Member Nov 1, 2018
David Jolly Individual Corporate OfficerCeo/President Jan 6, 2023
W-2 Managing EmployeeCeo/President Jan 6, 2023
Elizabeth L Miller Individual Corporate DirectorBoard Member Apr 23, 2024
Aretha Thompson Individual Corporate DirectorBoard Member Apr 27, 2021
Daniel Lamb Individual Corporate DirectorBoard Member Apr 25, 2017
Dareshanie D'Arpino Individual Corporate DirectorBoard Member Apr 23, 2024
Amy Ansehl Individual Corporate DirectorBoard Member Apr 27, 2021
Randall Volney Coffill Individual Corporate DirectorBoard Member Jun 27, 2023
Paul Ernenwein Individual Corporate DirectorBoard Member Jan 1, 2014
Inaudy Esposito Individual Corporate DirectorBoard Member Jan 25, 2022

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 67

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

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1841813623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W STE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181370",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BENTON AVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109405177",
            "telephone_number": "845-563-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE FAMILY HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CORNERSTONE FAMILY HEALTHCARE",
        "enumeration_date": "2020-05-27",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-220-3165"
    },
    "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": "The Greater Hudson Valley Family Health Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.