NPIMap

Organization Active NPI

Whitney M. Young Jr. Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Albany, NY
National Provider Identifier
1942660105
Registry record updated Jul 21, 2022
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
10 Dewitt Street
Whitney M. Young Jr. Health Center, Inc.
Albany, NY 12207-1300
Phone
(518) 465-4771
Fax
(518) 320-3022
NPI assigned
Mar 2, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WHITNEY M. YOUNG JR. HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Donna Connors
Title
Credentialing Specialist
Phone
(518) 465-4771

Specialties & licenses 1

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

Addresses

Primary practice location

10 Dewitt Street
Whitney M. Young Jr. Health Center, Inc.
Albany, NY 12207-1300

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
331807MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040821000073 NY Part B Supplier - Clinic/Group Practice 6507830031 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Albany, NY; Troy, NY; Watervliet, NY
O20170622001830 NY Part A Provider - Federally Qualified Health Center (FQHC) 6507830031 Practice locations: Albany, NY
O20200302000770 NY Part B Supplier - Opioid Treatment Program (Otp) 6507830031 Practice locations: Albany, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942660105. Details of each certification follow.

Federally qualified health center certification: CCN 571075

Legal name
WHITNEY M YOUNG JR HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 27, 2017
Last certification
Jun 27, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 5, 1974 in NY
Enrollment address
10 Dewitt St
Albany, NY 12207-2423

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 5

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
33D2078608Whitney M Young Jr Health Center - Dewitt Street10 Dewitt Street, Albany, NY 12207Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Whitney M Young Jr Health C15 organizations share this tax ID, including this one
Part of
Whitney M Young Jr Health C

Other organizations with this tax ID 14

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

View all 14

Locations

10 De Witt St
Albany, NY 12207
Phone (518) 463-3882

Ownership & related parties

All disclosed owners & managing parties 15

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 DirectorPresident and Ceo Apr 28, 2011
W-2 Managing EmployeePresident and Ceo 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
Sheila Nelson Individual Corporate DirectorBoard Member Apr 4, 2017
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 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

Practitioners & affiliated clinicians

Practitioners 73

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 73

NPI Registry JSON

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

{
    "created_epoch": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1942660105",
    "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",
            "fax_number": "518-320-3022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DEWITT STREET",
            "address_2": "WHITNEY M. YOUNG JR. HEALTH CENTER, INC.",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122071300",
            "telephone_number": "518-465-4771",
            "fax_number": "518-320-3022"
        }
    ],
    "practiceLocations": [],
    "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": "2016-03-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CONNORS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "518-465-4771",
        "authorized_official_name_prefix": "Ms."
    },
    "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": "331807",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, NY

Sources for this page

Verify at the official NPI Registry.