NPIMap

Organization Active NPI

Beth Israel Deaconess Hospital Plymouth, Inc.

  • General Acute Care Hospital
  • Plymouth, MA
National Provider Identifier
1043299001
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2082 Issued in MA
Legal business name
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.
Practice address
275 Sandwich St
Plymouth, MA 02360-2183
Phone
(508) 746-2000
Fax
(508) 830-1131
NPI assigned
Jan 10, 2006
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Jason M Radzevich
Title
V.P. of Finance and Cfo
Phone
(508) 830-2005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 2082 MA Primary

Addresses

Primary practice location

275 Sandwich St
Plymouth, MA 02360-2183

Mailing address

275 Sandwich St
Plymouth, MA 02360-2183
Phone (508) 746-2000

Other identifiers 9

IdentifierTypeStateIssuer
110024453CMedicaidMA
1001434MedicaidMA
900021OtherMATUFTS INPATIENT
000000020545OtherMABMC HEALTHNET
220060OtherMAMEDICARE PTAN
S012236OtherMACHAMPUS
900002OtherMAHPHC
2222006001OtherMABCBS MA INPATIENT
500444OtherMATUFTS 1500 PSYCH BILLING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030312000005 MA Part A Provider - Hospital 8224947536 1 other NPI on this enrollment
Practice locations: Plymouth, MA
O20050321000212 MA Part B Supplier - Clinic/Group Practice 8224947536 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plymouth, MA
O20050825000311 MA Part A Provider - Hospice 8224947536 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plymouth, MA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1043299001. Details of each certification follow.

Hospital certification: CCN 220060

Legal name
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 7, 2010
Beds
155
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1985 in MA
Enrollment address
275 Sandwich St
Plymouth, MA 23602183
Main/Primary Hospital Location
Hospital subgroups
Acute care

Hospice certification: CCN 221520B

Legal name
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC
Doing business as
CRANBERRY HOSPICE
Organization structure
CorporationNon-profit
Incorporated
Oct 26, 1984 in MA
Enrollment address
275 Sandwich St
East Building 1St Floor
Plymouth, MA 02360-2183

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).

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Beth Israel Deaconess Hospital PlymouthCCN 220060 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Cranberry Hospice3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 35

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

NameRoleSinceShare
Jamie Katz Individual Corporate DirectorClerk Jan 1, 2014
Kevin M Tabb Individual Corporate DirectorBoard Member & Pres. and Ceo Bilh Jan 1, 2014
Jeffrey H Kapell Individual Corporate DirectorBoard Member May 31, 2019
Beth Israel Lahey Health, Inc. Organization, Boston, MA Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2019 100%
Julia a Kenniston Individual Corporate Director Sep 19, 2023
Nicole Marie Mulkern Individual Corporate OfficerAssistant Chief Financial Officer Apr 19, 2022
Corporate Officer Apr 19, 2022
Sheilah Rangaviz Individual Corporate OfficerCfo Mar 10, 2024
Operational/Managerial ControlCfo Mar 10, 2024
Nate Horwitz-Willis Individual Corporate DirectorBoard Member May 31, 2019
Mary Dwyer Individual Corporate Officer Jan 2, 2013
Charles Hewitt Individual Corporate Director Jan 31, 2018
Kristina L. McGill Individual Corporate Director Oct 1, 2023
Catherine Grey Individual W-2 Managing Employee Aug 1, 1998
Raymond Blair Individual Corporate Director Oct 1, 2022
Harvey J Kowaloff Individual Corporate Director Mar 26, 2021
Anna Marini Individual Corporate Director Oct 1, 2020
David M Kelly Individual Corporate Director Jan 1, 2019
Alison Gilmore Carr Individual Corporate Director Oct 1, 2022
Jon McGrath Individual Corporate Director Oct 1, 2021
Kevin B Coughlin Individual Corporate OfficerPresident Jun 12, 2017
W-2 Managing Employee Sep 2, 2014
W-2 Managing EmployeePresident Sep 2, 2014
Erin E Burns Individual Corporate Director Oct 1, 2022
Catherine McKenna Individual Corporate Director Oct 1, 2021
Keelas Small Individual Corporate Director Nov 17, 2008
Thomas a Browning Individual Contracted Managing EmployeeMD; Nov 1, 2015
Joshua W Stuhlfaut Individual Corporate Director Sep 19, 2017
William Gagnon Individual Corporate Director Sep 18, 2013
Mary Ellen Lawrence Individual Corporate Director Apr 29, 2015
Stephen P Fischer Individual Corporate DirectorTreasurer Jan 1, 2014
John Carnuccio Individual Corporate Director Jun 2, 2008
Kenneth Fosdick Individual Corporate Director Nov 18, 2002
Clark Hinkley Individual Corporate Director Nov 15, 2004
Kimberly a Lonis-Scheub Individual Corporate Director Nov 7, 2008
Michael Babini Individual Corporate Director Jun 2, 2008
Lyle Bazzinotti Individual Corporate Director Nov 18, 2002
Deborah Dolaway Individual W-2 Managing EmployeeAd; Apr 1, 1987
Stephen M Trehu Individual Corporate Director Nov 16, 2009

Owners & managing parties with NPI records 5

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

Facilities with the same owner 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 73

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 73

Affiliated clinicians 827

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

View all 827

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1043299001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-746-2000",
            "fax_number": "508-830-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-746-2000",
            "fax_number": "508-830-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "RADZEVICH",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "V.P. OF FINANCE AND CFO",
        "authorized_official_telephone_number": "508-830-2005"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MA",
            "license": "2082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024453C",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001434",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS INPATIENT",
            "identifier": "900021",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BMC HEALTHNET",
            "identifier": "000000020545",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "220060",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "S012236",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "900002",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MA INPATIENT",
            "identifier": "2222006001",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS 1500 PSYCH BILLING",
            "identifier": "500444",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

Verify at the official NPI Registry.