NPIMap

Organization Active NPI

John T. Mather Memorial Hospital

  • General Acute Care Hospital
  • Port Jefferson, NY
National Provider Identifier
1093718728
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
5149000 Issued in NY
Legal business name
JOHN T. MATHER MEMORIAL HOSPITAL
Practice address
75 N Country Rd
Port Jefferson, NY 11777-2119
Phone
(631) 473-1320
Fax
(631) 686-1459
NPI assigned
May 27, 2005
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Mrs. Michele L Cusack
Title
Evp & Cfo
Phone
(516) 321-6058

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 5149000 NY
General Acute Care Hospital 282N00000X 5149000 NY Primary
Skilled Nursing Facility 314000000X 5149000 NY
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

75 N Country Rd
Port Jefferson, NY 11777-2119

Mailing address

75 N Country Rd
Port Jefferson, NY 11777-2190
Phone (631) 473-1320

Other identifiers 10

IdentifierTypeStateIssuer
00274364MedicaidNY
3044310MedicaidCT
HSP32196MedicaidCA
110851658MedicaidPA
100822MedicaidWA
6004504MedicaidNJ
21920MedicaidMD
1206575MedicaidMA
HSP42196MedicaidCA
3300185MedicaidNC

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address matherhospital@jtmmh.allscriptsdirect.net Health Information Exchange (HIE)
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark
FHIR URL https://fhirprod.matherhospital.org/ Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20081202000549 NY Part A Provider - Hospital 1254237753 Practice locations: Port Jefferson, NY; Port Jefferson Station, NY; East Setauket, NY
O20140219000075 NY Part A Provider - Hospital 1254237753 Practice locations: Port Jefferson, NY
O20210622000309 NY Part A Provider - Skilled Nursing Facility 1254237753 Practice locations: Port Jefferson, NY

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1093718728. Details of each certification follow.

Hospital certification: CCN 330185

Legal name
JOHN T MATHER MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 16, 2024
Beds
248
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 1928 in NY
Enrollment address
75 N Country Rd
Port Jefferson, NY 11777-2119
Other Hospital Practice Location
Hospital subgroups
Acute care

Hospital certification: CCN 33S185

Legal name
JOHN T MATHER MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 1928 in NY
Enrollment address
75 N Country Rd
Port Jefferson, NY 11777-2119
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Skilled nursing facility certification: CCN 335853

Legal name
JOHN T MATHER MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 4, 2007
Last certification
May 23, 2025
Beds
16
Ownership / control type
Individual
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 1928 in NY
Enrollment address
75 Ncountry Rd
Port Jefferson, NY 11777-2119
Nursing home name
JOHN T MATHER MEMORIAL HOSP T C U

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
John T Mather Memorial Hospital of Port JeffersonCCN 330185 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Nursing home

Medicare Care Compare
Listed as
John T Mather Memorial Hosp T C UCCN 335853 · All quality measures
Overall star rating
5 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Apr 4, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
1613.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

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

Interoperability endpoints

  • Direct secure messaging: matherhospital@jtmmh.allscriptsdirect.net

Ownership & related parties

All disclosed owners & managing parties 38

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

NameRoleSinceShare
Harold F Tranchon Individual Corporate OfficerBoard Member May 1, 1979
Corporate DirectorBoard Member May 1, 1979
Operational/Managerial ControlBoard Member May 1, 1979
Corporate DirectorB0Ard Member May 1, 1979
Christina M Iadanza Individual Corporate DirectorSenior Director Revenue Cycle Sep 12, 2016
W-2 Managing EmployeeSenior Director Revenue Cycle Sep 12, 2016
Operational/Managerial ControlSenior Director Revenue Cycle Sep 12, 2016
Corporate DirectorAdministrator Sep 12, 2016
W-2 Managing EmployeeAssistant Vice President Sep 12, 2016
Operational/Managerial ControlAdminstrator Sep 12, 2016
Kathryn B Frey Individual Corporate OfficerBoard Member Oct 1, 2005
Corporate DirectorBoard Member Oct 1, 2005
Operational/Managerial ControlBoard Member Oct 1, 2005
Corporate DirectorBoard Member Jul 1, 2005
Northwell, Inc. Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2024
Sharon E Donnelly Individual Corporate DirectorDirector of Physician Services Cont Feb 1, 2015
W-2 Managing EmployeeDirector of Physician Services Cont Feb 1, 2015
Corporate DirectorDirector Feb 1, 2015
Corporate DirectorDirector of Physcian Services Co Sep 12, 2016
W-2 Managing EmployeeDirector of Physician Services C Sep 12, 2016
Operational/Managerial ControlDirector of Physician Services C Sep 12, 2016
Christine Marie Ruggiero Individual Corporate DirectorVP Medical Board & Vice Chairman Jan 1, 2019
Corporate DirectorVP Medical Board & Vice Chairman Apr 1, 2019
Leo Sternlicht Individual Corporate OfficerBoard Member Nov 1, 2004
Corporate DirectorBoard Member Nov 1, 2004
Operational/Managerial ControlBoard Member Nov 1, 2004
Timothy Glynn Individual Corporate OfficerBoard Member Dec 1, 2011
Corporate DirectorBoard Member Dec 1, 2011
Operational/Managerial ControlBoard Member Dec 1, 2011
Betsy N Britton Individual Corporate OfficerBoard Member May 1, 1979
Corporate DirectorBoard Member May 1, 1979
Operational/Managerial ControlBoard Member May 1, 1979
Gerald M Miller Individual Corporate DirectorPatient Account Supervisor Sep 12, 2016
W-2 Managing EmployeePatient Account Supervisor Sep 12, 2016
Operational/Managerial ControlPatient Account Supervisor Sep 12, 2016
Christine Livreri Individual Corporate DirectorAvp Financial Planning Sep 12, 2016
W-2 Managing EmployeeAvp Financial Planning Sep 12, 2016
Operational/Managerial ControlAvp Financial Planning Sep 12, 2016
Operational/Managerial ControlAvp Financial Planning Jan 1, 2014
Operational/Managerial ControlManager Avp Financial Planning Sep 12, 2016
Mark L Claster Individual Corporate DirectorBoard Member Jun 1, 2021
John R Sini Individual Corporate OfficerBoard Member Nov 1, 1982
Corporate DirectorBoard Member Nov 1, 1982
Operational/Managerial ControlBoard Member Nov 1, 1982
Northwell Healthcare Inc Organization, Westbury, NY Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2015 100%
5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Donald E Lippencott Individual Corporate DirectorBoard Member Jan 1, 2019
Corporate DirectorBoard Member Jul 1, 2019
Northwell Health Inc Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015
Stephen J Bello Individual Corporate DirectorBoard Member Sep 1, 2019
Tara Scully Individual Corporate DirectorBoard Member Jun 1, 2021
Kenneth Douglas Roberts Individual Corporate OfficerPresident May 1, 1986
Corporate DirectorPresident May 1, 1986
W-2 Managing EmployeePresident May 1, 1986
Operational/Managerial ControlPresident May 1, 1986
Corporate OfficerPresident-Board Member May 1, 1986
Corporate Director May 1, 1986
W-2 Managing EmployeePresident-Board Member May 1, 1986
Operational/Managerial ControlPresident-Board Member May 1, 1986
Nicole Christian Individual Corporate DirectorBoard Member Jun 1, 2021
James Danowski Individual Corporate OfficerBoard Member Nov 1, 2004
Corporate DirectorBoard Member Nov 1, 2004
Operational/Managerial ControlBoard Member Nov 1, 2004
Edward J Weiss Individual Corporate OfficerBoard Member Feb 1, 1988
Corporate DirectorBoard Member Feb 1, 1988
Operational/Managerial ControlBoard Member Feb 1, 1988
Debra Lois Engelhardt Individual Corporate OfficerBoad Member Sep 1, 2015
Corporate DirectorBoard Member Sep 1, 2015
Operational/Managerial ControlBoard Member Sep 1, 2015
Corporate OfficerBoard Member Sep 1, 2015
Marvin Colson Individual Corporate DirectorBoard Member Jul 1, 2019
Maritza L Groth Individual Corporate DirectorMember at Large Jun 1, 2021
Konrad J Kuhn Individual Corporate OfficerBoard Member May 1, 1978
Corporate DirectorBoard Member May 1, 1978
Operational/Managerial ControlBoard Member May 1, 1978
William Mader Individual W-2 Managing Employee Aug 1, 2023
W-2 Managing EmployeeData Engineer Aug 1, 2023
Roger a Blumencranz Individual Corporate OfficerBoard Member Feb 1, 2018
Corporate DirectorBoard Member Feb 1, 2018
Operational/Managerial ControlBoard Member Feb 1, 2018
John J Yu Individual Corporate DirectorBoard Member Jan 1, 2019
Corporate DirectorBoard Member Apr 1, 2019
John Diviney Individual Corporate OfficerBoard Member May 1, 2014
Corporate DirectorBoard Member May 1, 2014
Operational/Managerial ControlBoard Member May 1, 2014
Corporate DirectorBoard Member Apr 1, 2019
Ralph a Nappi Individual Corporate OfficerBoard Member Jan 1, 2018
Corporate DirectorBoard Member May 29, 2018
Operational/Managerial ControlBoard Member May 29, 2018
Corporate DirectorBoard Member Jan 1, 2018
Operational/Managerial ControlBoard Member Jan 1, 2018
Corporate DirectorBoard Member May 1, 1978
Kevin McGeachy Individual Corporate DirectorExecutive Director Jun 1, 2021
Mohammad a Bilal Individual Corporate DirectorBoard of Director Jun 1, 2021
OtherVP, Medical Staff & Vice Chairman Jun 1, 2021
Sylvia Diaz Individual Corporate DirectorBoard Member Jul 1, 2019
Michele L Cusack Individual Corporate OfficerSenior Vice President & Cfo Jan 1, 2018
Joseph Wisnoski Individual Corporate DirectorVP Finance/Cfo Jan 1, 2009
W-2 Managing EmployeeVP Finance/Cfo Sep 12, 2016
Operational/Managerial ControlVP Finance/Cfo Jul 16, 2013
OtherVP Finance/Cfo Jul 21, 2009
Corporate DirectorVP Finance/Cfo Jun 1, 2009
W-2 Managing EmployeeVP Finance/Cfo Jul 12, 2016
Operational/Managerial ControlFinance/Cfo Jul 16, 2013
Joseph NG Individual W-2 Managing EmployeeMedical Director Aug 1, 2023
Nicholas Craig Individual Corporate OfficerBoard Member Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2017
Operational/Managerial ControlBoard Member Jan 1, 2017

Owners & managing parties with NPI records 7

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

Facilities with the same owner 42

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

View all 42

Practitioners & affiliated clinicians

Practitioners 44

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 44

Affiliated clinicians 859

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

View all 859

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1093718728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772190",
            "telephone_number": "631-473-1320",
            "fax_number": "631-473-5254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 N COUNTRY RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772119",
            "telephone_number": "631-473-1320",
            "fax_number": "631-686-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN T. MATHER MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NY",
            "license": "5149000",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NY",
            "license": "5149000",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5149000",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274364",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3044310",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP32196",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110851658",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100822",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6004504",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21920",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1206575",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP42196",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3300185",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matherhospital@jtmmh.allscriptsdirect.net",
            "affiliation": "N",
            "endpointDescription": "Mather Hospital MedAllies Direct Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "75 N Country Rd",
            "city": "Port Jefferson",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117772119",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhirprod.matherhospital.org/",
            "affiliation": "N",
            "endpointDescription": "Mather Hospital FHIR API",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "75 N Country Rd",
            "city": "Port Jefferson",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117772119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

Verify at the official NPI Registry.