NPIMap

Organization Active NPI

Community Health Project Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooklyn, NY
National Provider Identifier
1962040246
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH PROJECT INC.
Practice address
40 Flatbush Avenue Extension
Brooklyn, NY 11201
Phone
(212) 271-7200
NPI assigned
Dec 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Authorized official

Name
Wendy Elizabeth Stark
Title
Executive Director
Phone
(212) 271-7191

Specialties & licenses 1

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

Addresses

Primary practice location

40 Flatbush Avenue Extension
Brooklyn, NY 11201

Mailing address

356 W 18TH St
New York, NY 10011
Phone (212) 271-7191

Other names 1

  • Callen-Lorde Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325001467 NY Part B Supplier - Clinic/Group Practice 1254223217 Receives reassigned benefits from 99 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY; Brooklyn, NY; New York, NY
O20200904001223 NY Part A Provider - Federally Qualified Health Center (FQHC) 1254223217 Practice locations: Brooklyn, NY

Federally qualified health center certification: CCN 571806

Legal name
COMMUNITY HEALTH PROJECT, INC.
Doing business as
CALLEN-LORDE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 4, 2020
Last certification
Sep 4, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 14, 1985 in NY
Enrollment address
40 Flatbush Avenue Ext
FL 3
Brooklyn, NY 11201-2903

Other NPIs with the same Medicare PAC ID 8

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.

National Provider Directory

National Provider Directory
Tax ID family
Community Health Project11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

356 W 18th St
Ste 6
New York, NY 10011

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
William Craig Individual Corporate DirectorBoard Member Jan 9, 2019
James Evans Individual Corporate DirectorBoard Secretary May 11, 2016
Paul Shay Individual Corporate DirectorBoard Member Mar 19, 2025
Bethany Jankunis Individual Corporate DirectorBoard Member Nov 13, 2019
Vickie Tillman Individual Corporate DirectorTreasurer Sep 21, 2022
Carl Gaines Individual Corporate DirectorBoard Vice Chair Sep 12, 2018
Patrick McGovern Individual Corporate DirectorChief Executive Officer Aug 1, 2023
W-2 Managing EmployeeChief Executive Officer Aug 1, 2023
Matthew McMorrow Individual Corporate DirectorBoard Member Mar 19, 2025
Blane Charles Individual Corporate DirectorBoard Member Nov 13, 2019
Shane Stephen Spicer Individual Corporate DirectorBoard Member Apr 29, 2015
Daniel McGee Individual Corporate DirectorBoard Member Jun 21, 2017
June Stafford Individual Corporate DirectorBoard Member Jun 27, 2018
Matthew Cohen Individual Corporate DirectorBoard Chair Oct 28, 2015
Lanita Ward Jones Individual Corporate DirectorBoard Member Oct 28, 2015
Giselle Byrd Individual Corporate DirectorBoard Member Jun 16, 2021
Bella Batista Individual Corporate DirectorBoard Member Sep 21, 2022
William G Pagano Individual Corporate DirectorBoard Member Jun 21, 2017
Faiz Osman Individual Corporate DirectorBoard Member Mar 20, 2024

Practitioners & affiliated clinicians

Practitioners 90

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

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576540800000",
    "number": "1962040246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "356 W 18TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10011",
            "telephone_number": "212-271-7191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 FLATBUSH AVENUE EXTENSION",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "212-271-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH PROJECT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A",
        "authorized_official_last_name": "STARK",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "212-271-7191"
    },
    "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": "Callen-Lorde Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Callen-Lorde Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.