NPIMap

Johnson Memorial Hospital, Inc.

Organization Active NPI Psychiatric Hospital Unit · Stafford Springs, CT

NPI 1053480293 · NPPES record last updated Mar 3, 2026

Key facts

NPI
1053480293
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatric Hospital Unit 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
Organization subpart
Yes
Parent organization (as reported)
TRINITY HEALTH - NEW ENGLAND, INC.

Authorized official

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

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

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    NPD member Member Of

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

Facilities with the same owner 157

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

View all 157

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 242

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

View all 242

Medicare Care Compare: Hospital

Listed as
Johnson Memorial Hospital CCN 070008
Overall star rating
★★★☆☆ 3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CT

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
Corporation · Non-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
Corporation · Non-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

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 Director
Board Member		 Jan 1, 2025
Garrett Casey
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Juan Miguel Betancourt
Individual 		Corporate Director
Board Member		 Jan 1, 2020
Corporate Director
" Board Member"		 Jan 1, 2020
James M Harris
Individual 		Corporate Officer
Regional Director of Reimbursement		 Feb 7, 2017
Operational/Managerial Control
Regional Director of Reimbursement		 Feb 21, 2019
Barbara Mullen
Individual 		Corporate Director
Board Member		 Jan 1, 2019
Corporate Director
" Board Member"		 Jan 1, 2019
Walter Harrison
Individual 		Corporate Officer
Vice-Chair		 Jan 1, 2024
Corporate Director
Board Member		 Jan 1, 2019
Corporate Officer
Vice Chair		 Jan 4, 2024
Corporate Director
"Board Member"		 Jan 1, 2019
John Kinney
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Robert Anthony
Individual 		Contracted Managing Employee
General Counsel		 Sep 1, 2017
Corporate Officer
Secretary		 Jan 1, 2019
Michelle Theroux
Individual 		Corporate Director
Board Member		 Jan 1, 2022
Corporate Director
"Board Member"		 Jan 1, 2022
Joann Price
Individual 		Corporate Officer
Chair		 Jan 1, 2024
Corporate Director
Board Member		 Jan 1, 2019
Corporate Director
"Board Member"		 Jan 1, 2019
Arosha Jayawickrema
Individual 		Corporate Director
Board Member		 Jan 1, 2024
Corporate Director
Board Director		 Jan 1, 2024
Nancy Kroeber
Individual 		Corporate Director
Board Member		 Jan 1, 2022
Corporate Director
"Board Member"		 Jan 1, 2022
David Carter
Individual 		Corporate Officer
President, Ceo & BD. Member		 Oct 3, 2022
Corporate Director
President, Ceo & BD. Member		 Oct 3, 2022
Antonio S Perugino
Individual 		Corporate Officer
Treasurer		 Nov 4, 2024
Operational/Managerial Control
VF Finance and Cfo		 Nov 4, 2024
Operational/Managerial Control
VP 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 Officer
President		 Apr 20, 2022
Operational/Managerial Control Apr 20, 2022
Operational/Managerial Control
President		 Apr 20, 2022
Tina Weatherwax Grant
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Stuart Kilpinen
Individual 		Operational/Managerial Control
Chain Home Office Administrator		 Jun 10, 2023
Karl J Krapek
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Corporate Director
"Board Member"		 Jan 1, 2021
Sheri Lemieux
Individual 		Corporate Officer
Assistant Secretary		 Jan 1, 2019

Medicare enrollment records

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

National Provider Directory

Tax ID family
Johnson Memorial Hospital I (2 organizations share this tax ID)

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X 0072 CT
Psychiatric Hospital Unit 273R00000X Yes
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

Other identifiers

IdentifierTypeStateIssuer
4024980MedicaidCT
4041687MedicaidCT

Electronic endpoints

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 3, 2026.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4024980",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4041687",
            "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 Stafford Springs, CT

All providers in Stafford Springs, CT · Psychiatric Hospital Unit in Connecticut

Sources for this page

Verify at the official NPI Registry.