NPIMap

Organization Active NPI

Mount Sinai Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Hartford, CT
National Provider Identifier
1053357533
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
License
17CD Issued in CT
Legal business name
MOUNT SINAI REHABILITATION HOSPITAL, INC.
Practice address
490 Blue Hills Ave
Hartford, CT 06112-1513
Phone
(860) 714-4953
NPI assigned
Jun 21, 2006
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Valerie Powell-Stafford
Title
President
Phone
(860) 714-5387

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X 17CD CT Primary

Addresses

Primary practice location

490 Blue Hills Ave
Hartford, CT 06112-1513

Mailing address

114 Woodland St
Hartford, CT 06105-1208
Phone (860) 714-4000

Other identifiers 3

IdentifierTypeStateIssuer
358444OtherCTWELLCARE
4147717MedicaidCT
H433125OtherCTOXFORD

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060719000242 CT Part A Provider - Hospital 7911818281 1 other NPI on this enrollment
Practice locations: Hartford, CT; West Hartford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053357533. Details of each certification follow.

Hospital certification: CCN 073025

Legal name
MOUNT SINAI REHABILITATION HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Jun 15, 1995
Last certification
Jan 26, 2006
Beds
60
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Apr 18, 1995 in CT
Enrollment address
490 Blue Hills Ave
Hartford, CT 61121513
Other Hospital Practice Location
Hospital subgroups
Rehabilitation

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Mount Sinai Rehabilitation Hospital IncCCN 073025 · All quality measures
Ownership
Non-profit
Certified
Jun 15, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Wesley Knauft Individual Corporate DirectorBoard Member Jan 1, 2025
Garrett Casey Individual Corporate DirectorBoard Member Jan 1, 2025
Juan Miguel Betancourt Individual Corporate Director" Board Member" Jan 1, 2020
James M Harris Individual Corporate OfficerRegional Director of Reimbursement Jul 1, 2012
Operational/Managerial ControlRegional Director of Reimbursement Oct 1, 2015
Barbara Mullen Individual Corporate Director" Board Member" Jan 1, 2019
Walter Harrison Individual Corporate OfficerVice Chair Jan 1, 2024
Corporate Director"Board Member" Jan 1, 2019
John Kinney Individual Corporate DirectorBoard Member Jan 1, 2024
Robert Anthony Individual Corporate OfficerSecretary Jan 1, 2019
Michelle Theroux Individual Corporate Director"Board Member" Jan 1, 2022
Joann Price Individual Corporate OfficerChair Jan 1, 2024
Corporate Director" Board Member" Jan 1, 2019
Arosha Jayawickrema Individual Corporate DirectorBoard Member Jan 1, 2024
Nancy Kroeber Individual Corporate Director"Board Member" Jan 1, 2022
David Carter Individual Corporate OfficerReg. President & Ceo Oct 3, 2022
Corporate DirectorReg. President, Ceo & Board Member Oct 3, 2022
Antonio S Perugino Individual Corporate OfficerTreasurer Nov 4, 2024
Operational/Managerial ControlVP of Finance and Cfo Nov 4, 2024
Trinity Health of New England Corporation Inc Organization, Hartford, CT Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 1, 2015 100%
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Oct 1, 2015 100%
Tina Weatherwax Grant Individual Corporate DirectorBoard Member Jan 1, 2025
Valerie Powell-Stafford Individual Corporate OfficerPresident Feb 27, 2025
Stuart Kilpinen Individual Operational/Managerial ControlChain Home Office Administrator Jun 10, 2023
Karl J Krapek Individual Corporate Director"Board Member" Jan 1, 2021
Sheri Lemieux Individual Corporate OfficerAssistant Secretary Jan 1, 2019

Owners & managing parties with NPI records 1

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

Facilities with the same owner 157

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

View all 157

Practitioners & affiliated clinicians

Affiliated clinicians 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1053357533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-714-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 BLUE HILLS AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121513",
            "telephone_number": "860-714-4953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT SINAI REHABILITATION HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY HEALTH OF NEW ENGLAND CORPORATION, INC.",
        "enumeration_date": "2006-06-21",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "POWELL-STAFFORD",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-714-5387"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "CT",
            "license": "17CD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "358444",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4147717",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "H433125",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.