NPIMap

Organization Active NPI

Soldiers & Sailors Memorial Hospital

Doing business as Soldiers & Sailors Memorial Hospital Hospitalist

  • Emergency Medicine Physician
  • Penn Yan, NY
National Provider Identifier
1043353618
Registry record updated Mar 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Doing business as
Soldiers & Sailors Memorial Hospital Hospitalist
Practice address
418 N Main St
Penn Yan, NY 14527-1070
Phone
(315) 787-4150
Fax
(315) 787-4794
NPI assigned
Feb 14, 2007
Last updated
Mar 3, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
SOLDIERS & SAILORS MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2017

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

Authorized official

Name
Ms. Pamela E Johnson
Title
Treasurer & Cfo
Phone
(315) 787-4030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

418 N Main St
Penn Yan, NY 14527-1070

Mailing address

418 N Main St
Penn Yan, NY 14527-1070
Phone (315) 787-4150

Other identifiers 1

IdentifierTypeStateIssuer
02657812MedicaidNY

Other names 1

  • SOLDIERS & SAILORS MEMORIAL HOSPITAL HOSPITALIST Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000348 NY Part B Supplier - Clinic/Group Practice 0446164255 Receives reassigned benefits from 125 practitioners
1 other NPI on this enrollment
Practice locations: Dundee, NY; Penn Yan, NY

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Soldiers and Sailors Me

Locations

8000 Box
Buffalo, NY 14267
Phone (716) 213-0772

418 N Main St
#2N
Penn Yan, NY 14527

418 N Main St
Ofc
Penn Yan, NY 14527
Phone (315) 531-2000

1991 Balsley Rd
Ste 1
Seneca Falls, NY 13148

367 E Main St
Waterloo, NY 13165
Phone (315) 539-0580

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 170

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 170

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488499200000",
    "number": "1043353618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 N MAIN ST",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271070",
            "telephone_number": "315-787-4150",
            "fax_number": "315-787-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 N MAIN ST",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271070",
            "telephone_number": "315-787-4150",
            "fax_number": "315-787-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLDIERS & SAILORS MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOLDIERS & SAILORS MEMORIAL HOSPITAL",
        "enumeration_date": "2007-02-14",
        "last_updated": "2017-03-03",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "TREASURER & CFO",
        "authorized_official_telephone_number": "315-787-4030",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02657812",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOLDIERS & SAILORS MEMORIAL HOSPITAL HOSPITALIST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Penn Yan, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.