Canton-Potsdam Hospital

Primary specialty

Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X

Legal business name

CANTON-POTSDAM HOSPITAL

Practice address

50 Leroy Street
Potsdam, NY 13676

Phone

(315) 265-3300

Fax

(315) 265-5745

NPI assigned

Jan 29, 2008

Last updated

Oct 15, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Donna McGregor

Title

Cfo

Phone

(315) 261-5451

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114104445. Details of each certification follow.

• CCN 33U197 Hospital · Details

Hospital certification: CCN 33U197

Legal name

CANTON-POTSDAM HOSPITAL

Organization structure

CorporationNon-profit

Incorporated

May 5, 1922 in NY

Enrollment address

50 Leroy St
Potsdam, NY 13676-1786
Hospital Swing-Bed Unit

Hospital subgroups

Swing-bed approved

Related certifications (CCN) 1

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

• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782

  Unit of hospital

  Provider of Services

Other NPIs with the same Medicare PAC ID 1

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

• Canton-Potsdam Hospital

  • General Acute Care Hospital
  • Potsdam, NY
  • NPI 1568548782

  6204827280

  Same PAC ID

Locations

All disclosed owners & managing parties 24

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

Owners & managing parties with NPI records 3

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

• Florence C Bero, M.D.

  • Family Medicine Physician
  • Canton, NY
  • NPI 1508864539

  Corporate Director

  CMS ownership
• Imre Kayvan Rainey-Spence, M.D.

  • Internal Medicine Physician
  • Potsdam, NY
  • NPI 1982862181

  Corporate Director

  CMS ownership
• Michael Joseph Tulloch, MD

  • Internal Medicine Physician
  • Potsdam, NY
  • NPI 1780625715

  Corporate Director

  CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Northern Lights Health Care Partnership Inc

  dba Northern Lights Home Health Care

  • Home Health Agency
  • Ogdensburg, NY
  • NPI 1881037604

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 423

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.

• David Abbatematteo, MD

  • Pain Medicine (Anesthesiology) Physician
  • Potsdam, NY
  • NPI 1003194812
  NPD
• Mazin Ismail Abdullah, M.D

  • Obstetrics & Gynecology Physician
  • Potsdam, NY
  • NPI 1831241629
  NPD
• Joseph John Adams IV, FNP-C

  • Family Nurse Practitioner
  • Potsdam, NY
  • NPI 1164984753
  NPD
• Amanda Lynn Agley, PA-C

  • Physician Assistant
  • Watertown, NY
  • NPI 1730748419
  NPD
• Nabras Ahmed, D.O.

  • Gastroenterology Physician
  • West Islip, NY
  • NPI 1285022483
  NPD
• Nargish Akhter

  • Hospitalist Physician
  • Bronx, NY
  • NPI 1457748832
  NPD
• Asad Ali, MBBS

  • Gastroenterology Physician
  • Syracuse, NY
  • NPI 1437454188
  NPD
• Syed Haider Ali, MD

  • Internal Medicine Physician
  • Canton, NY
  • NPI 1801810304
  NPD
• Mohsen S Alshamam, MD

  • Internal Medicine Physician
  • Jamaica, NY
  • NPI 1710448113
  NPD
• Sanjay Kevin Anandaram, MD

  • Neurology Physician
  • Rochester, NY
  • NPI 1013262153
  NPD
• Kathleen Patricia Andrews, MD

  • Pediatric Cardiology Physician
  • Syracuse, NY
  • NPI 1366805830
  NPD
• Mariam Hasanali Asar, MD

  • Child & Adolescent Psychiatry Physician
  • Potsdam, NY
  • NPI 1649479239
  NPD

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

{
    "created_epoch": "1201564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1114104445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY STREET",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-265-3300",
            "fax_number": "315-265-5745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 LEROY STREET",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "13676",
            "telephone_number": "315-265-3300",
            "fax_number": "315-265-5745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON-POTSDAM HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-29",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "MCGREGOR",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "315-261-5451",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kahlia Burruss, MS, LMHC-P
• David C Butler, PH.D.
• Victor Michael Caamano, P.T., M.A.
• Katherine McCarney Calcagno, RN
• Canton Potsdam Hospital
• Canton-Potsdam Hospital
• Canton-Potsdam Hospital (CPH Emergency Physicians)
• Canton-Potsdam Hospital (CPH Anesthesiology Physicians)
• Elizabeth Carey, R.PH.
• Christine Mary Carr, LPN

• Medicare Defined Swing Bed Hospital Unit in Potsdam, NY
• Providers in Potsdam, NY by specialty
• Medicare Defined Swing Bed Hospital Unit in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.