NPIMap

Organization Active NPI

Whitney M. Young Jr. Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, NY
National Provider Identifier
1871190017
Registry record updated Oct 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Practice address
700 Washington Ave
Albany, NY 12203-1404
Phone
(518) 475-6290
Fax
(518) 475-6291
NPI assigned
Oct 1, 2020
Organization subpart
Yes
Parent organization
WHITNEY M. YOUNG JR. HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2020

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

Authorized official

Name
David Harold Shippee
Title
President and Ceo
Phone
(518) 591-4459

Specialties & licenses 1

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

Addresses

Primary practice location

700 Washington Ave
Albany, NY 12203-1404

Mailing address

920 Lark Dr
Albany, NY 12207-1300
Phone (518) 465-4771

Other practice location 1

920 Lark Dr
Albany, NY 12207-1300
Phone (518) 465-4771

Other names 1

  • Albany High School Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211008001428 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY

Federally qualified health center certification: CCN 571820

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 5, 2021
Last certification
Oct 5, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 11, 2007 in NY
Enrollment address
700 Washington Ave
Albany, NY 12203-1404

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Whitney M Young Troy Health15 organizations share this tax ID, including this one
Part of
Whitney M Young Troy Health

Other organizations with this tax ID 14

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

View all 14

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
Gus Birkhead Individual Corporate DirectorBoard Member Apr 12, 2022
Casey Parker Individual Corporate DirectorBoard Member Apr 6, 2021
Charles Welge Individual Corporate DirectorBoard Member Apr 9, 2024
David Harold Shippee Individual Corporate OfficerCeo/President Apr 28, 2011
Corporate DirectorCeo/President Apr 28, 2011
W-2 Managing EmployeeCeo/President Apr 28, 2011
Marlowe Cochran Individual Corporate DirectorBoard Member Apr 5, 2016
Rosalyn Duvall Individual Corporate DirectorBoard Member Apr 11, 2023
Gary Guy Individual Corporate DirectorBoard Member Apr 11, 2023
Annette Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
Susanne M Isabella Individual Corporate DirectorRevenue Cycle Director Jul 23, 2021
W-2 Managing EmployeeRevenue Cycle Director Jul 23, 2021
Ceylon Moore Individual Corporate DirectorBoard Member Jun 6, 2016
Tracey Johnson Individual Corporate DirectorBoard Member Apr 11, 2023
John E Fraher Individual Corporate OfficerCfo Nov 19, 2018
Corporate DirectorCfo Nov 19, 2018
W-2 Managing EmployeeCfo Nov 19, 2018
Kelli Arnold Individual Corporate DirectorBoard Member May 14, 2024
Lauri Rosmarin-Plattner Individual Corporate DirectorBoard Member Apr 11, 2023

NPI Registry JSON

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1871190017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 LARK DR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300",
            "telephone_number": "518-465-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WASHINGTON AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122031404",
            "telephone_number": "518-475-6290",
            "fax_number": "518-475-6291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Lark Dr",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122071300",
            "country_code": "US",
            "telephone_number": "518-465-4771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WHITNEY M. YOUNG JR. HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITNEY M. YOUNG JR. HEALTH CENTER, INC.",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "SHIPPEE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "518-591-4459"
    },
    "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": "Albany High School",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.