NPIMap

Organization Active NPI

Charles Evans Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Bethpage, NY
National Provider Identifier
1972982007
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
2950212R Issued in NY
Legal business name
CHARLES EVANS CENTER, INC.
Practice address
857 S Oyster Bay Rd
Bethpage, NY 11714-1030
Phone
(516) 622-8888
Fax
(516) 342-2480
NPI assigned
May 21, 2015
Last updated
Jun 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Authorized official

Name
Rebeca Rosa Rivera
Title
Revenue Cycle Manager
Phone
(516) 622-8888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 2950212R NY Primary

Addresses

Primary practice location

857 S Oyster Bay Rd
Bethpage, NY 11714-1030

Mailing address

857 S Oyster Bay Rd
Bethpage, NY 11714-1030
Phone (516) 622-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150803000284 NY Part A Provider - Federally Qualified Health Center (FQHC) 1759695992 Practice locations: Bethpage, NY
O20160427000454 NY Part B Supplier - Clinic/Group Practice 1759695992 Receives reassigned benefits from 66 practitioners
2 other NPIs on this enrollment
Practice locations: Glen Cove, NY; Seaford, NY; Bethpage, NY
O20200316001887 NY Part A Provider - Federally Qualified Health Center (FQHC) 1759695992 2 other NPIs on this enrollment
Practice locations: Glen Cove, NY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1972982007. Details of each certification follow.

Federally qualified health center certification: CCN 331152

Legal name
CHARLES EVANS CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 3, 2015
Last certification
Aug 3, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 19, 2015 in NY
Enrollment address
857S Oyster Bay Rd
Bethpage, NY 11714-1030

Federally qualified health center certification: CCN 571196

Legal name
CHARLES EVANS CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2020
Last certification
Mar 16, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
113 Glen Cove Ave
Glen Cove, NY 11542-3438

Other NPIs with the same Medicare PAC ID 2

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.

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
33D2112061Charles Evans Center Inc857 S Oyster Bay Road, Bethpage, NY 11714Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Charles Evans Center Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
John a. Javis Individual Corporate DirectorExecutive Director Apr 1, 2025 100%
W-2 Managing EmployeeAd; Apr 1, 2025 100%
Operational/Managerial ControlExecutive Director Apr 1, 2025 100%
Diane Peterson Individual Corporate DirectorBoard Member May 19, 2015 100%
Corporate DirectorBoard Member Dec 3, 2019
Mary Cody Individual W-2 Managing EmployeeAccounts Receivable Manger Dec 3, 2019
Anne Emmerson Individual Corporate DirectorBoard Member May 19, 2015 100%
Corporate DirectorBoard Member Dec 3, 2019
Robert C Goldsmith Individual Corporate DirectorBoard Member May 19, 2015 100%
Corporate DirectorBoard Member Dec 3, 2019
Scott a Ross Individual Corporate DirectorBoard Member May 19, 2015 100%
Ronald Tauss Individual Corporate DirectorBoard Member May 19, 2015 100%
Corporate DirectorBoard Member Dec 3, 2019
Ellen Spiegel Individual Corporate DirectorBoard Member May 19, 2015 100%
Peter a. Egan Individual Corporate DirectorBoard Member Dec 3, 2019
Iris Rosenthal Individual Corporate DirectorBoard Member Dec 3, 2019

Practitioners & affiliated clinicians

Practitioners 66

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 66

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782345600000",
    "number": "1972982007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "857 S OYSTER BAY RD",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117141030",
            "telephone_number": "516-622-8888",
            "fax_number": "516-342-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "857 S OYSTER BAY RD",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117141030",
            "telephone_number": "516-622-8888",
            "fax_number": "516-342-2480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES EVANS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A",
        "authorized_official_last_name": "ROSA RIVERA",
        "authorized_official_first_name": "REBECA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "516-622-8888"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "2950212R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

Verify at the official NPI Registry.