NPIMap

Organization Active NPI

Jericho Road Ministries Inc.

  • Federally Qualified Health Center (FQHC)
  • Buffalo, NY
National Provider Identifier
1972944080
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
JERICHO ROAD MINISTRIES INC.
Practice address
184 Barton St
Buffalo, NY 14213
Phone
(716) 881-6191
Fax
(716) 881-6247
NPI assigned
Jul 17, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Authorized official

Name
Jackie Endress
Title
Credentialing Specialist
Phone
(716) 348-3000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Early Intervention Provider Agency 252Y00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

184 Barton St
Buffalo, NY 14213

Mailing address

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 881-6191

Other practice location 1

1500 Main St
Buffalo, NY 14209-1722
Phone (716) 503-9777

Other identifiers 1

IdentifierTypeStateIssuer
1401237ROtherNYNYS OPERATING LICENSE

Other names 1

  • Jericho Road Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20131220000412 NY Part A Provider - Federally Qualified Health Center (FQHC) 5597992933 Practice locations: Buffalo, NY
O20150116000533 NY Part B Supplier - Clinic/Group Practice 5597992933 Receives reassigned benefits from 52 practitioners
4 other NPIs on this enrollment
Practice locations: Buffalo, NY
O20181023002193 NY Part A Provider - Federally Qualified Health Center (FQHC) 5597992933 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Buffalo, NY
O20251002003748 NY Part A Provider - Federally Qualified Health Center (FQHC) 5597992933 Practice locations: Buffalo, NY

Federally qualified health center certification: CCN 331090

Legal name
JERICHO ROAD MINISTRIES, INC.
Doing business as
JERICHO ROAD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 30, 2014
Last certification
Jan 30, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 31, 2003 in NY
Enrollment address
184 Barton St
Buffalo, NY 14213-1573
Related CCNs
331089

Federally qualified health center certification: CCN 571129

Legal name
JERICHO ROAD MINISTRIES, INC.
Doing business as
JERICHO ROAD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 23, 2018
Last certification
Oct 23, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 31, 2003 in NY
Enrollment address
1021 Broadway St
Buffalo, NY 14212-1460

Federally qualified health center certification: CCN 571918

Legal name
JERICHO ROAD MINISTRIES, INC.
Doing business as
JERICHO ROAD COMMUNITY HEALTH CENTER VIVE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 3, 2025
Last certification
Sep 3, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1500 Main St
Buffalo, NY 14209-1722

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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
33D0930191Jericho Road Community Health Center184 Barton Street, Buffalo, NY 14213Provider-performed microscopyMar 26, 2027
33D2305889Jericho Road Community Health Center1500 Main St, Buffalo, NY 14209Provider-performed microscopyMar 26, 2027

National Provider Directory

National Provider Directory

Locations

1021 Broadway St
Buffalo, NY 14212
Phone (716) 529-3020

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Donna Darrell Individual Corporate DirectorBoard Member Feb 1, 2011
Corporate OfficerBoard Member Feb 17, 2011
Corporate OfficerBoard Member Feb 9, 2011
Katie Badeau Individual Corporate DirectorBoard Member Sep 25, 2025
Myron L Glick Individual W-2 Managing EmployeeMedical Doctor Oct 4, 2025
W-2 Managing EmployeeMedical Doctor Jul 1, 2019
W-2 Managing Employee Sep 13, 2013
Martha Burt Individual Corporate DirectorBoard Member Jun 27, 2024
Corporate OfficerBoard Member Jun 27, 2024
Fidele Menavanza Individual Corporate OfficerChief Compliance Officer Feb 28, 2022
Adoni Nyamuke Individual Corporate DirectorBoard Member Mar 24, 2022
Corporate Director Mar 24, 2022
Corporate OfficerBoard Member Mar 24, 2022
John Hurley Individual Corporate DirectorBoard Member Jun 27, 2024
Corporate OfficerBoard Member Jun 27, 2024
Luther K Robinson Individual Corporate DirectorBoard Member Oct 31, 2024
Corporate OfficerBoard Member Oct 31, 2024
Paul Harris Individual Corporate DirectorBoard Member Aug 26, 2021
Corporate DirectorBoard Aug 26, 2021
Corporate OfficerBoard Member Aug 26, 2021
Chris Jhu Individual Corporate DirectorBoard Member Dec 19, 2024
Corporate OfficerBoard Member Dec 19, 2024
John Lee Individual Corporate DirectorBoard Member Dec 10, 2010
Corporate OfficerFinance Dec 16, 2010
Corporate OfficerBoard Member Dec 10, 2010
David Holmes Individual Corporate DirectorBoard Member Dec 10, 2010
Corporate DirectorBoard Aug 26, 2021
Corporate OfficerBoard Member Sep 27, 2018
Faustina Palmatier Individual Corporate DirectorBoard Member Sep 26, 2024
Corporate OfficerBoard Member Sep 26, 2024
Lawaye Htoo Individual Corporate DirectorBoard Member Sep 17, 2015
Corporate OfficerBoard Member Sep 17, 2015
Corporate OfficerBoard Member Sep 10, 2015
Mark Herskind Individual Corporate DirectorBoard Member Sep 28, 2023
Corporate OfficerBoard Member Sep 28, 2023
Connie Jozwiak-Fields Individual Corporate DirectorBoard Member Aug 1, 2009
Corporate OfficerBoard Member Jul 21, 2005
Seraphine Sargent Individual Corporate DirectorBoard Member Nov 19, 2024
Corporate OfficerBoard Member Nov 19, 2024
Allana Marie Krolikowski Individual Corporate DirectorC.E.O. Oct 4, 2025
Corporate OfficerChief Executive Officer Jul 1, 2019
W-2 Managing EmployeeC.E.O. Dec 1, 2023
Corporate OfficerChief Executive Officer Oct 4, 2025
Veronica Koller Individual Corporate OfficerChief Financial Officer Jul 8, 2024
Jill Meyer Individual Corporate DirectorBoard Member Mar 24, 2022
Corporate Director Mar 24, 2022
Corporate OfficerBoard Member Mar 24, 2022
Karen Dann Individual Corporate OfficerChief Pharmacy Services Officer Jul 3, 2023
Maggie Nichols Individual Corporate OfficerChief Operations Officer Oct 26, 2020
W-2 Managing EmployeeC.O.O. Dec 1, 2023
Jackie Endress Individual Corporate DirectorCredentialing Specialist Oct 1, 2014
Kayla Gleason Individual Corporate OfficerChief Strategic Planning Officer May 24, 2021
Immanuel Day Individual Corporate OfficerChief Administration Officer Jul 3, 2023
Jericho Road Ministries, Inc. Organization, Buffalo, NY Non-profit Operational/Managerial Control Jul 1, 2025

Owners & managing parties with NPI records 9

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

Practitioners & affiliated clinicians

Practitioners 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754352000000",
    "number": "1972944080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14213",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Main St",
            "address_purpose": "LOCATION",
            "city": "Buffalo",
            "state": "NY",
            "postal_code": "142091722",
            "country_code": "US",
            "telephone_number": "716-503-9777",
            "fax_number": "716-503-9778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JERICHO ROAD MINISTRIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A",
        "authorized_official_last_name": "ENDRESS",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "716-348-3000"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS OPERATING LICENSE",
            "identifier": "1401237R",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jericho Road Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jericho Road Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.