NPIMap

Organization Active NPI

Mosaic Health, Inc.

Doing business as Rushville Health Center

  • Federally Qualified Health Center (FQHC)
  • Rushville, NY
National Provider Identifier
1912225236
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOSAIC HEALTH, INC.
Doing business as
Rushville Health Center
Practice address
2 Rubin Dr
Rushville, NY 14544-9681
Phone
(585) 554-4400
NPI assigned
May 11, 2010
Last updated
May 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Lisa Olscamp
Title
Cfo
Phone
(585) 325-2280

Specialties & licenses 1

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

Addresses

Primary practice location

2 Rubin Dr
Rushville, NY 14544-9681

Mailing address

1 S Washington St Ste 300
Rochester, NY 14614-1134
Phone (585) 325-2280

Other identifiers 1

IdentifierTypeStateIssuer
00618199MedicaidNY

Other names 2

  • Rushville Health Center Doing business as
  • Rochester Primary Care Network, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110309000547 NY Part B Supplier - Clinic/Group Practice 4385826585 Receives reassigned benefits from 28 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ilion, NY; Rushville, NY; Utica, NY
O20110802000493 NY Part A Provider - Federally Qualified Health Center (FQHC) 4385826585 1 other NPI on this enrollment
Practice locations: Rushville, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912225236. Details of each certification follow.

Federally qualified health center certification: CCN 331029

Legal name
MOSAIC HEALTH, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 23, 2011
Last certification
Sep 23, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1987 in NY
Enrollment address
2 Rubin Dr
Rushville, NY 14544-9681

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Shana Dahlin Individual Corporate DirectorBoard Member Jan 1, 2023
James Waters Individual Corporate Director Jan 24, 2011
Dominic Galante Individual Corporate Director Jan 24, 2004
Kevin P Loughran Individual Corporate DirectorBoard Member Jan 2, 2018
Michael J Leary Individual Corporate OfficerCeo Jul 1, 2010
W-2 Managing Employee Jul 1, 2010
Donald Ginsberg Individual Corporate Director Jul 1, 1987
Lisa Olscamp Individual Corporate OfficerCfo Aug 17, 2009
W-2 Managing Employee Aug 17, 2009
Gerald Giudice Individual Corporate DirectorBoard Member Jan 1, 2017
George Haizlip Individual Corporate Director Jan 24, 2011
Freddie Lee Caldwell Individual Corporate DirectorBoard Member Oct 1, 2014
John C Gleason Individual Corporate DirectorBoard Member Jan 1, 2019
Lydia I Rivera-Warr Individual Corporate DirectorBoard Member Sep 3, 2019
Susan Hustleby Individual Corporate Director Sep 28, 2009

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1912225236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S WASHINGTON ST STE 300",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146141134",
            "telephone_number": "585-325-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 RUBIN DR",
            "city": "RUSHVILLE",
            "state": "NY",
            "postal_code": "145449681",
            "telephone_number": "585-554-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-11",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "OLSCAMP",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "585-325-2280"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00618199",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rushville Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rushville Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rochester Primary Care Network, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Rushville, NY

Sources for this page

Verify at the official NPI Registry.