Sun River Health Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

5901200R Issued in NY

Legal business name

SUN RIVER HEALTH INC

Practice address

1556 Straight Path
Wyandanch, NY 11798-3213

Phone

(516) 214-8020

Fax

(516) 214-8022

NPI assigned

Jul 21, 2014

Last updated

Mar 13, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

SUN RIVER HEALTH INCAs reported in NPPES

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

Authorized official

Name

Adam Lipton

Title

VP Info/Practice MGMT Systems

Phone

(914) 384-2375

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• HRHCare Wyandanch Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952718181. Details of each certification follow.

• CCN 331120 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 331120

Legal name

SUN RIVER HEALTH INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 16, 2014

Last certification

Oct 16, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 5, 1975 in NY

Enrollment address

1556 Straight Path
Wyandanch, NY 11798-3213

Other NPIs on the same Medicare enrollment 1

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

• Sun River Health Inc.

  • Federally Qualified Health Center (FQHC)
  • Peekskill, NY
  • NPI 1619969458

  O20141011000033

  Same enrollment

Part of

Hudson River Healthcare Inc

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.

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647129600000",
    "number": "1952718181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5036",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106025036",
            "telephone_number": "914-734-8800",
            "fax_number": "914-734-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 STRAIGHT PATH",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "117983213",
            "telephone_number": "516-214-8020",
            "fax_number": "516-214-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN RIVER HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUN RIVER HEALTH INC",
        "enumeration_date": "2014-07-21",
        "last_updated": "2022-03-13",
        "certification_date": "2022-03-13",
        "status": "A",
        "authorized_official_last_name": "LIPTON",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "VP INFO/PRACTICE MGMT SYSTEMS",
        "authorized_official_telephone_number": "914-384-2375"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5901200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473038",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HRHCare Wyandanch",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shatika Smith, NP
• SMS1 Pharmacy Corp (medical center pharmacy of wyndanch)
• Jill Virginia Spadafora, LMHC-D
• Roslyn St. Rose, CASAC-T
• Patricia Maria Suazo, HHA
• Liana Kristen Sventoraitis, LCSW
• Sweetness- Yb Inc (Yvette-Benita Bowman)
• Celine Tambe
• Delma Dawn Taylor, LMSW
• Crystal Tobias, RN

• Federally Qualified Health Center (FQHC) in Wyandanch, NY
• Providers in Wyandanch, NY by specialty
• Federally Qualified Health Center (FQHC) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.