NPIMap

Organization Active NPI

Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Queensbury, NY
National Provider Identifier
1013292002
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
161 Carey Rd
Queensbury, NY 12804-7821
Phone
(518) 824-8610
Fax
(518) 824-2390
NPI assigned
Oct 21, 2011
Organization subpart
Yes
Parent organization
HUDSON HEADWATERS HEALTH NETWORKAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Laura Pasco
Title
Executive VP, Cfo
Phone
(518) 761-0300

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 27

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

View all 27

Corporate family (same tax ID) 42

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

View all 42

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

Practitioners 5

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NY

Federally qualified health center certification: CCN 331033

Legal name
HUDSON HEADWATERS HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2011
Last certification
Dec 15, 2011
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Jul 15, 1981 in NY
Enrollment address
161 Carey Rd
Queensbury, NY 12804-7821
Related CCNs
331850

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
Kristina Hermance
Individual 		Corporate Officer
VP, Logistics		 Jul 23, 2023
Stephen T Shafer
Individual 		Corporate Director
Board Member		 Jul 25, 2024
Linda Spokane
Individual 		Corporate Officer
President & Program Director, Pace		 Oct 23, 2017
Tracy Mills
Individual 		Corporate Officer
Executive VP, Network Strategy		 Jan 3, 2022
Vicki Demarse-Giroux
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Kevin Dougrey
Individual 		Corporate Officer
VP, Medical Staff Operations		 Aug 31, 2020
David Tucker Slingerland
Individual 		Corporate Officer
Ceo		 Jun 1, 2014
Laura S Pasco
Individual 		Corporate Officer
Executive VP, Finance & Cfo		 Sep 19, 2022
W-2 Managing Employee
Executive VP, Finance & Cfo		 Jan 14, 2024
Thomas Dodd
Individual 		Corporate Director
Board Member, Vice-Chairperson		 Nov 18, 2021
Jill Coombes
Individual 		Corporate Officer
VP, Compliance, Cco		 Apr 5, 2020
Deana Ketchum
Individual 		Corporate Director
Board Member, at Large Member		 Feb 24, 2022
Jessica Rubin
Individual 		Corporate Officer
VP, Chief Impact Officer		 Apr 5, 2020
Christine a Rowe-Button
Individual 		Corporate Director
Board Member, Secretary		 Nov 18, 2021
James J Morris
Individual 		Corporate Director
Board Member, Treasurer		 Feb 25, 2016
Robert Nemer
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Justin Miller
Individual 		Corporate Officer
Evp, Chief Information Officer		 Jan 15, 2024
Susan Corney
Individual 		Corporate Officer
Executive VP, Human Resources		 Sep 6, 2017
William M Borgos
Individual 		Corporate Officer
Chief Medical Officer		 Oct 1, 2019
Darren Woods
Individual 		Corporate Director
Board Member		 Feb 16, 2023
Matthew Henderson
Individual 		Corporate Officer
Executive VP, General Counsel		 Dec 29, 2019
Patricia a Auer
Individual 		Corporate Director
Board Member		 Feb 25, 2021
Cathleen Traver
Individual 		Corporate Officer
VP, Planning and Grants		 Sep 18, 2023
Brittany Silvestri
Individual 		Corporate Officer
Evp, Chief Operating Officer		 Aug 8, 2021
Maureen Poole
Individual 		Corporate Officer
VP, Nursing		 Oct 3, 2021
Peter Reale
Individual 		Corporate Director
Board Member		 Feb 25, 2016
Donna Nichols
Individual 		Corporate Director
Board Member, Chairperson		 Jun 28, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031117000239 NY Part B Supplier - Clinic/Group Practice 7416861208 Receives reassigned benefits from 266 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupper Lake, NY; Warrensburg, NY; Ticonderoga, NY; Schroon Lake, NY; Saranac Lake, NY; Salem, NY; Queensbury, NY; Plattsburgh, NY…
O20111214000232 NY Part a Provider - Federally Qualified Health Center (FQHC) 7416861208 Practice locations: Queensbury, NY

National Provider Directory

Tax ID family
Hudson Headwaters HLTH (43 organizations share this tax ID)
Part of
Hudson Headwaters HLTH

Specialties & licenses 15

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Sports Medicine (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PS0010X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X
Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RR0500X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Federally Qualified Health Center (FQHC) 261QF0400X 5660200R NY
Primary Care Clinic/Center 261QP2300X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

NPPES NPI Registry

Primary practice location

161 Carey Rd
Queensbury, NY 12804-7821

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
03470413MedicaidNY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 23, 2024.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1013292002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047821",
            "telephone_number": "518-824-8610",
            "fax_number": "518-824-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2011-10-21",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE VP, CFO",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5660200R",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03470413",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queensbury, NY

Sources for this page

Verify at the official NPI Registry.