Canton-Potsdam Hospital
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Potsdam, NY
NPI 1114104445 · NPPES record last updated Oct 15, 2020
Key facts
- NPI
- 1114104445
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 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
- Organization subpart
- No
Authorized official
- Name
- Ms. Donna McGregor
- Title
- Cfo
- Phone
- (315) 261-5451
Owners & managing parties with NPI records 3
-
Florence C Bero, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Practitioners 439
-
Joseph John Adams IV, FNP-C
-
Asad Ali, MBBS
-
Bradley Ashcroft, MD
-
Meenakshi Bansal, MD
-
Jillian Bartling, D.O.
-
Frank Bateman, RPAC
-
John William Batich, M.D.
-
Nicholas A. Bavaro, M.D.
-
Evelyn Olga Berman, M.D. M.S.
-
Gwen Lindsey Bonner, M.D.
-
Andrea Anne Bonno, FNP-C
-
Emma Brackett, LCSW
-
Kiri Pryjma Brandy, M.D.
-
Eric N Bravin, M.D.
-
Flos C Brown, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Hospital certification: CCN 33U197
- Legal name
- CANTON-POTSDAM HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 5, 1922 in NY
- Enrollment address
- 50 Leroy St
Potsdam, NY 13676-1786 - Hospital subgroups
- Swing-bed approved
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| Lenore Vanderzee,PHD. |
Corporate Director | Oct 14, 2025 | |
| James Theodore |
Corporate Director |
Jul 1, 2009 | |
| Florence CL Bero |
Corporate Director |
Sep 1, 2015 | |
| Kelly Cicchinelli |
Corporate Officer |
May 20, 2022 | |
| Jacquelyn Kuno |
Corporate Director |
Jan 25, 2018 | |
| Mark Cornett |
Corporate Director |
Jul 1, 2012 | |
| Nichole S Holder |
Corporate Officer |
Jan 21, 2021 | |
| Stacey Cannizzo |
Corporate Director | Oct 14, 2025 | |
| Richard O Davis |
Corporate Director | Oct 14, 2025 | |
| Imre K Rainey Spence |
Corporate Director | Oct 14, 2025 | |
| Anne Marie Snell |
Corporate Director | Oct 14, 2025 | |
| Ashley Peggs |
W-2 Managing Employee |
Oct 14, 2025 | |
| Michael Griffin |
Corporate Director |
Jul 1, 2010 | |
| Kristen Roberts |
Corporate Director | Oct 14, 2025 | |
| Howard Glastonbury |
Corporate Officer |
Jan 21, 2021 | |
| Edward Mucenski |
Corporate Director |
May 1, 2000 | |
| Paul Cole |
Corporate Director |
Jul 1, 2009 | |
| Thomas Adams |
Corporate Director | Oct 14, 2025 | |
| Michael Joseph Tulloch |
Corporate Director |
Jul 1, 2006 | |
| Donna McGregor |
Corporate Officer |
Aug 1, 2020 | 50% |
| W-2 Managing Employee |
Aug 1, 2020 | 50% | |
| Paul McGrath |
Corporate Director |
Jul 1, 1998 | |
| Catherine Blevins |
Corporate Director |
Jan 25, 2018 | |
| Thomas R Crilly |
Corporate Officer |
Jan 21, 2021 | |
| Judith Chase |
Corporate Director |
Jul 1, 2003 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Northern Lights Home Health Care |
Home health agency | 5% Or Greater Direct Ownership Interest (33.33%) | Aug 27, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210610000065 | NY | Part a Provider - Hospital | 6204827280 | Practice locations: Potsdam, NY |
National Provider Directory
Locations
145 Market St
Potsdam, NY 13676
Phone (315) 268-8240
725 Irving Ave
#A
Syracuse, NY 13210
Phone (315) 214-7700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
50 Leroy Street
Potsdam, NY 13676
Mailing address
50 Leroy Street
Potsdam, NY 13676
Phone (315) 265-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4429000H | Medicaid | NY |
Other providers in Potsdam, NY
- Kahlia Burruss
- David C Butler
- Victor Michael Caamano
- Katherine McCarney Calcagno
- Canton Potsdam Hospital
- Canton-Potsdam Hospital
- Canton-Potsdam Hospital
- Canton-Potsdam Hospital
- Elizabeth Carey
- Christine Mary Carr
All providers in Potsdam, NY · Medicare Defined Swing Bed Hospital Unit in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.