NPIMap

Organization Active NPI

Gouverneur Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Gouverneur, NY
National Provider Identifier
1023449709
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
4423000C Issued in NY
Legal business name
GOUVERNEUR HOSPITAL
Practice address
77 W Barney St
Gouverneur, NY 13642-1040
Phone
(315) 287-1000
Fax
(315) 535-9235
NPI assigned
Dec 6, 2013
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Ms. Donna McGregor
Title
Ceo
Phone
(315) 261-6059

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 4423000C NY Primary

Addresses

Primary practice location

77 W Barney St
Gouverneur, NY 13642-1040

Mailing address

77 W Barney St
Gouverneur, NY 13642-1040
Phone (315) 287-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140318001797 NY Part A Provider - Critical Access Hospital 9931336724 Practice locations: Gouverneur, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023449709. Details of each certification follow.

Hospital certification: CCN 33Z315

Legal name
GOUVERNEUR HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 2013 in NY
Enrollment address
77W Barney St
Gouverneur, NY 13642-1040

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Gouverneur Hospital6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

25 Wilson St
Gouverneur, NY 13642
Phone (315) 287-1903

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kelly Cicchinelli Individual W-2 Managing EmployeeController Jan 1, 2019
Courtney Bish Individual Corporate Director Oct 14, 2025
Andrew J Leonard Individual Corporate DirectorBoard Member Jan 1, 2014
Nichole S Holder Individual Corporate OfficerDirector of Payer Enrollments Jan 21, 2021
Richard O Davis Individual Corporate Director Oct 14, 2025
Donald C Schuessler Individual Corporate Director Oct 14, 2025
Andrew F Williams Individual Corporate Director Jan 1, 2014
Ashley Peggs Individual W-2 Managing Employee Oct 14, 2025
Howard Glastonbury Individual Corporate OfficerVP Cfo Corporate Finance Jan 21, 2021
Bart Kidwell Individual Corporate Director Oct 14, 2025
Theodore Totten Individual Corporate DirectorBoard Member May 19, 2022
St.Lawrence Health System, Inc. Organization, Potsdam, NY Non-profit Operational/Managerial Control Jan 1, 2014
Donna McGregor Individual Corporate OfficerSLHS Senior VP of Finance Jul 26, 2021
Thomas R Crilly Individual Corporate OfficerExecutive VP Cfo Jan 21, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 11

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.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1023449709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-1000",
            "fax_number": "315-535-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-1000",
            "fax_number": "315-535-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOUVERNEUR HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "MCGREGOR",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-261-6059",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NY",
            "license": "4423000C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gouverneur, NY

Sources for this page

Verify at the official NPI Registry.