| Details | Last Recertification Date | Update | Recertification | 8/22/2023 2:26:23 PM | 8/29/2024 10:22:01 AM | 8/29/2024 10:22 AM |
| Details | Last Recertification Date | Update | Recertification | 8/30/2022 12:43:43 PM | 8/22/2023 2:26:23 PM | 8/22/2023 2:26 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2021 3:42:47 PM | 8/30/2022 12:43:43 PM | 8/30/2022 12:43 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 4:31:55 PM | 9/2/2021 3:42:47 PM | 9/2/2021 3:42 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Minlionica, Kathleen
Director of Pharmacy
The Brooklyn Hospital Center
7182508255 | Minlionica, Kathleen
Director of Pharmacy, Per diem
The Brooklyn Hospital Center
7182508220 | 10/14/2020 4:18 PM |
| Addresses | Billing Address | Insert | Change Request | | The Brooklyn Hospital Center
121 DeKalb Avenue
Br, NY 11201 | 10/13/2020 9:36 AM |
| Addresses | Shipping Address | Insert | Change Request | | The Brooklyn Hospital Center
121 DeKalb Avenue
Brooklyn, NY 11201 | 10/13/2020 9:36 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1326046467 ( ) | | 9/2/2020 4:31 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1326046467 | 9/2/2020 4:31 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NY | 9/2/2020 4:31 PM |
| Details | Last Recertification Date | Update | Recertification | 8/28/2019 4:28:58 PM | 9/2/2020 4:31:55 PM | 9/2/2020 4:31 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2018 3:58:53 PM | 8/28/2019 4:28:58 PM | 8/28/2019 4:28 PM |
| Details | Last Recertification Date | Update | Recertification | 11/10/2017 10:19:43 AM | 8/23/2018 3:58:53 PM | 8/23/2018 3:58 PM |
| Contacts | Authorizing Official | Update | Change Request | Semenza, Patrick
VP and Chief Financial Officer
The Brooklyn Hospital Center
7184883715 | Minarcik, Donald P.
VP Revenue Enhancement
The Brooklyn Hospital Center
7184883775 | 1/3/2018 7:49 AM |
| Contacts | Primary Contact | Update | Recertification | Schleider, Katherine
SVP, Clinical Integration
7182506699 | Minlionica, Kathleen
Director of Pharmacy
The Brooklyn Hospital Center
7182508255 | 11/10/2017 10:19 AM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/10/2017 10:19:43 AM | 11/10/2017 10:19 AM |
| Contacts | Authorizing Official | Update | | Semenza, Patrick
VP and Chief Financial Officer
7184883715 | Semenza, Patrick
VP and Chief Financial Officer
The Brooklyn Hospital Center
7184883715 | 10/20/2017 8:46 AM |
| Contacts | Authorizing Official | Insert | | | Semenza, Patrick
VP and Chief Financial Officer
7184883715 | 8/2/2017 7:13 AM |
| Contacts | Signed By | Insert | | | Guarracino, Joseph
Senior Vice President and CFO
7182506755 | 7/25/2017 11:42 AM |
| Addresses | Main Address | Insert | | |
99 Division Avenue
Brooklyn, NY 11211 | 7/25/2017 11:16 AM |
| Contacts | Primary Contact | Update | | Shedwell, Amber
VP Ambulatory Care
7182506702 | Schleider, Katherine
SVP, Clinical Integration
7182506699 | 7/25/2017 11:16 AM |
| Details | Last Recertification Date | Update | | 8/20/2015 12:00:00 AM | 8/23/2016 12:00:00 AM | 8/23/2016 4:24 PM |
| Contacts | Primary Contact | Update | | Shedwell, Amber
VICE PRESIDENT, AMBULATORY CARE
7182506702 | Shedwell, Amber
VP Ambulatory Care
7182506702 | 5/18/2016 12:12 PM |
| Contacts | Primary Contact | Update | | VASWANI, DAVINA
VICE PRESIDENT, AMBULATORY CARE
7182508653 | Shedwell, Amber
VICE PRESIDENT, AMBULATORY CARE
7182506702 | 5/18/2016 12:10 PM |
| Details | Last Recertification Date | Update | | 8/11/2014 12:00:00 AM | 8/20/2015 12:00:00 AM | 8/20/2015 4:28 PM |
| Contacts | Primary Contact | Insert | | | VASWANI, DAVINA
VICE PRESIDENT, AMBULATORY CARE
7182508653 | 8/11/2014 10:11 AM |
| Details | Last Recertification Date | Update | | | 8/11/2014 12:00:00 AM | 8/11/2014 10:11 AM |
| Dates | Participating Approval Date | Update | | | 9/13/2013 12:00:00 AM | 9/13/2013 1:21 PM |
| Details | State | Update | | Pending | Active | 9/13/2013 1:21 PM |
| Dates | Start Date | Update | | | 10/1/2013 12:00:00 AM | 9/13/2013 1:21 PM |
| Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG | DSH330056M | 8/1/2013 3:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/10/2013 10:41 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 00243614 | 7/10/2013 10:41 AM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 7/10/2013 10:41 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1326046467 | 7/10/2013 10:41 AM |
| Details | Last Recertification Date | Insert | | | | 7/10/2013 10:41 AM |
| Details | Grant Number | Insert | | | | 7/10/2013 10:41 AM |
| Details | 340B ID | Insert | | | OUTPATIENT_ONLINE_REG | 7/10/2013 10:41 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/10/2013 10:41 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/10/2013 10:41 AM |
| Details | Medicare Provider Number | Insert | | | 330056 | 7/10/2013 10:41 AM |
| Details | Entity Name | Insert | | | THE BROOKLYN HOSPITAL CENTER | 7/10/2013 10:41 AM |
| Details | Program Code | Insert | | | DSH | 7/10/2013 10:41 AM |
| Details | Entity Subname | Insert | | | Williamsburg Family Health Center | 7/10/2013 10:41 AM |
| Dates | Participating Approval Date | Insert | | | | 7/10/2013 10:41 AM |
| Details | State | Insert | | | Pending | 7/10/2013 10:41 AM |
| Dates | Registration Date | Insert | | | 7/10/2013 12:00:00 AM | 7/10/2013 10:41 AM |
| Dates | Signed By Date | Insert | | | 7/10/2013 12:00:00 AM | 7/10/2013 10:41 AM |
| Dates | Start Date | Insert | | | | 7/10/2013 10:41 AM |
| Terminations | Termination Comments | Insert | | | | 7/10/2013 10:41 AM |
| Terminations | Termination Date | Insert | | | | 7/10/2013 10:41 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/10/2013 10:41 AM |
| Terminations | Termination Reason | Insert | | | | 7/10/2013 10:41 AM |