NPIMap

Organization Active NPI

Northern Oswego County Health Services, Inc.

  • Community Health Clinic/Center
  • Fulton, NY
National Provider Identifier
1891195095
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Practice address
510 S 4TH St
Suite 600
Fulton, NY 13069-2904
Phone
(315) 598-4790
Fax
(315) 593-6195
NPI assigned
Aug 26, 2014
Organization subpart
Yes
Parent organization
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Authorized official

Name
Tracy Lynne Wimmer
Title
Sr. VP/Cfo
Phone
(315) 298-6569

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

510 S 4TH St
Suite 600
Fulton, NY 13069-2904

Mailing address

510 S 4TH St
Suite 600
Fulton, NY 13069-2904
Phone (315) 598-4790

Other names 1

  • Fulton Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150219000365 NY Part A Provider - Federally Qualified Health Center (FQHC) 8426961541 Practice locations: Fulton, NY

Federally qualified health center certification: CCN 331138

Legal name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 19, 2015
Last certification
Feb 19, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 24, 1969 in NY
Enrollment address
510 S 4TH St
Ste 600
Fulton, NY 13069-2952

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Northern Oswego Co Heal17 organizations share this tax ID, including this one
Part of
Northern Oswego Co Heal

Other organizations with this tax ID 16

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

View all 16

Locations

716 Academy St
Fulton, NY 13069
Phone (315) 298-6815

639 County Route 22
Parish, NY 13131
Phone (315) 625-5213

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Tracy Wimmer Individual Corporate OfficerVice President Cfo Jul 1, 2018 5%
W-2 Managing Employee Mar 7, 2016
David Dingman Individual Corporate Director Apr 1, 2019
Steven Gaffney Individual Corporate Officer Apr 1, 2020
Tricia Peter Clark Individual Corporate OfficerPresident Ceo Jun 4, 2021 5%
W-2 Managing Employee Jul 26, 2004
Michael Backus Individual Corporate Officer Apr 1, 2015
Robert Trainham Individual Corporate Director Apr 1, 2015
Timothy McCluskey Individual Corporate Officer Apr 1, 2007
Corporate Director Apr 1, 1999
Felicity Hallanan Individual Corporate Director Jun 1, 2010
Kathleen McLeod Individual Corporate Director Jan 2, 2007
James Oldenburg Individual Corporate Director Apr 1, 2018
Susan Lobdell Individual Corporate Director Apr 1, 2018
Judith Catella Individual Corporate Director Apr 1, 1988
Micheal D Stephens Individual Corporate Director Apr 1, 2020
Robert Oustrich Individual Corporate Director Apr 1, 2017
Lauren Seiter Individual Corporate Director Apr 1, 2016
Rose Ann Jerrett Individual Corporate Officer Apr 1, 2008
Corporate Director Aug 1, 2003

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northern Oswego County Health Services, Inc.Phoenix, NY, CCN 331135 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331133 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Mexico, NY, CCN 331132 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2013
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331139 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2012
Northern Oswego County Health Services, Inc.Parish, NY, CCN 331140 Federally qualified health center Operational/Managerial Control (100%) Jan 20, 2008
Northern Oswego County Health Services, Inc.Mexico, NY, CCN 331142 Federally qualified health center Operational/Managerial Control (100%) Jan 24, 2014
Northern Oswego County Health Services, Inc.Pulaski, NY, CCN 331141 Federally qualified health center Operational/Managerial Control (100%) Feb 28, 2004
Northern Oswego County Health Services, Inc.Pulaski, NY, CCN 331144 Federally qualified health center Operational/Managerial Control (100%) Feb 28, 2004

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625616000000",
    "number": "1891195095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 S 4TH ST",
            "address_2": "SUITE 600",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130692904",
            "telephone_number": "315-598-4790",
            "fax_number": "315-593-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S 4TH ST",
            "address_2": "SUITE 600",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130692904",
            "telephone_number": "315-598-4790",
            "fax_number": "315-593-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.",
        "enumeration_date": "2014-08-26",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A",
        "authorized_official_last_name": "WIMMER",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "SR. VP/CFO",
        "authorized_official_telephone_number": "315-298-6569"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fulton Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fulton Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fulton, NY

Sources for this page

Verify at the official NPI Registry.