NPIMap

Organization Active NPI

Johnson Memorial Hospital, Inc.

  • Psychiatric Hospital Unit
  • Stafford Springs, CT
National Provider Identifier
1053480293
Registry record updated Mar 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
JOHNSON MEMORIAL HOSPITAL, INC.
Practice address
201 Chestnut Hill Rd
Stafford Springs, CT 06076-4005
Phone
(860) 684-4251
NPI assigned
Nov 6, 2006
Last updated
Mar 3, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY HEALTH - NEW ENGLAND, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2026

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

Authorized official

Name
Antonio Perugion
Title
Vice President and Regional Cfo
Phone
(860) 714-4714

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 0072 CT
Psychiatric Hospital Unit 273R00000X Primary
General Acute Care Hospital 282N00000X 0072 CT

Addresses

Primary practice location

201 Chestnut Hill Rd
Stafford Springs, CT 06076-4005

Mailing address

201 Chestnut Hill Rd
Stafford Springs, CT 06076-4005
Phone (860) 684-4251

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 CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160218000626 CT Part A Provider - Hospital 4486959137 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Enfield, CT; Stafford Springs, CT
O20160218000983 CT Part A Provider - Hospital 4486959137 Practice locations: Stafford Springs, CT

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1053480293. Details of each certification follow.

Hospital certification: CCN 070008

Legal name
JOHNSON MEMORIAL HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 21, 2014
Beds
92
Ownership / control type
Private (not for profit)
Most recent change of ownership
Dec 31, 2015 (5 total)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2016 in CT
Enrollment address
201 Chestnut Hill Rd
Stafford Springs, CT 60764005
Other Hospital Practice Location
Hospital subgroups
Acute care, Psychiatric unit

Hospital certification: CCN 07S008

Legal name
JOHNSON MEMORIAL HOSPITAL INC
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2016 in CT
Enrollment address
201 Chestnut Hill Rd
Stafford Springs, CT 60764005
Hospital Psychiatric Unit
Hospital subgroups
Acute care, Psychiatric unit

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
Johnson Memorial HospitalCCN 070008 · All quality measures
Overall star rating
3 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
Johnson Memorial Hospital I2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

140 Hazard Ave
Ste 106
Enfield, CT 06082
Phone (860) 272-2960

151 Hazard Ave
Ste 2
Enfield, CT 06082
Phone (860) 763-7628

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 DirectorBoard Member Jan 1, 2020
Corporate Director" Board Member" Jan 1, 2020
James M Harris Individual Corporate OfficerRegional Director of Reimbursement Feb 7, 2017
Operational/Managerial ControlRegional Director of Reimbursement Feb 21, 2019
Barbara Mullen Individual Corporate DirectorBoard Member Jan 1, 2019
Corporate Director" Board Member" Jan 1, 2019
Walter Harrison Individual Corporate OfficerVice-Chair Jan 1, 2024
Corporate DirectorBoard Member Jan 1, 2019
Corporate OfficerVice Chair Jan 4, 2024
Corporate Director"Board Member" Jan 1, 2019
John Kinney Individual Corporate DirectorBoard Member Jan 1, 2024
Robert Anthony Individual Contracted Managing EmployeeGeneral Counsel Sep 1, 2017
Corporate OfficerSecretary Jan 1, 2019
Michelle Theroux Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate Director"Board Member" Jan 1, 2022
Joann Price Individual Corporate OfficerChair Jan 1, 2024
Corporate DirectorBoard Member Jan 1, 2019
Corporate Director"Board Member" Jan 1, 2019
Arosha Jayawickrema Individual Corporate DirectorBoard Member Jan 1, 2024
Corporate DirectorBoard Director Jan 1, 2024
Nancy Kroeber Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate Director"Board Member" Jan 1, 2022
David Carter Individual Corporate OfficerPresident, Ceo & BD. Member Oct 3, 2022
Corporate DirectorPresident, Ceo & BD. Member Oct 3, 2022
Antonio S Perugino Individual Corporate OfficerTreasurer Nov 4, 2024
Operational/Managerial ControlVF Finance and Cfo Nov 4, 2024
Operational/Managerial ControlVP 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 Jan 1, 2016 100%
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2016 100%
Robert J Roose Individual Corporate OfficerPresident Apr 20, 2022
Operational/Managerial Control Apr 20, 2022
Operational/Managerial ControlPresident Apr 20, 2022
Tina Weatherwax Grant Individual Corporate DirectorBoard Member Jan 1, 2025
Stuart Kilpinen Individual Operational/Managerial ControlChain Home Office Administrator Jun 10, 2023
Karl J Krapek Individual Corporate DirectorBoard Member Jan 1, 2021
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

Practitioners 9

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 242

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

View all 242

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772496000000",
    "number": "1053480293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 CHESTNUT HILL RD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060764005",
            "telephone_number": "860-684-4251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 CHESTNUT HILL RD",
            "city": "STAFFORD SPRINGS",
            "state": "CT",
            "postal_code": "060764005",
            "telephone_number": "860-684-4251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY HEALTH - NEW ENGLAND, INC.",
        "enumeration_date": "2006-11-06",
        "last_updated": "2026-03-03",
        "certification_date": "2026-03-03",
        "status": "A",
        "authorized_official_last_name": "PERUGION",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "VICE PRESIDENT AND REGIONAL CFO",
        "authorized_official_telephone_number": "860-714-4714"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "0072",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CT",
            "license": "0072",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Stafford Springs, CT

Sources for this page

Verify at the official NPI Registry.