NPIMap

Organization Active NPI

Fairview Hospital

Doing business as Williamstown Medical

  • Rural Health Clinic/Center
  • Williamstown, MA
National Provider Identifier
1124686530
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAIRVIEW HOSPITAL
Doing business as
Williamstown Medical
Practice address
197 Adams Rd
Williamstown, MA 01267-2930
Phone
(413) 458-8182
NPI assigned
May 31, 2019
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FAIRVIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Darlene M Rodowicz
Title
Chief Financial Officer
Phone
(413) 447-3003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

197 Adams Rd
Williamstown, MA 01267-2930

Mailing address

PO Box 1728
Pittsfield, MA 01202-1728
Phone (413) 447-3003

Other names 1

  • Williamstown Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191104000162 MA Part A Provider - Rural Health Clinic 1254240773 Practice locations: Williamstown, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124686530. Details of each certification follow.

Rural health clinic certification: CCN 223978

Legal name
FAIRVIEW HOSPITAL
Doing business as
WILLIAMSTOWN MEDICAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 30, 2019
Last certification
Sep 30, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 19, 1912 in MA
Enrollment address
197 Adams Rd
Williamstown, MA 01267-2930
Related CCNs
221302

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Fairview Hospital Inc5 organizations share this tax ID, including this one
Part of
Fairview Hospital Inc

Other organizations with this tax ID 4

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

Member of 1

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

Locations

197 Adams Rd
#A
Williamstown, MA 01267

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
David Hall Individual Corporate Director Sep 30, 2019
Rebecca P Caine Individual W-2 Managing Employee Dec 23, 2022
Alfred a Barbalunga Individual Corporate Director Sep 30, 2019
Fairview Hospital Organization, Great Barrington, MA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 30, 2019 100%
Susan Kormanik Individual Corporate DirectorDirector Jan 1, 2023
Deborah Renzi Individual Corporate DirectorDirector Jan 1, 2024
Leticia S E Haynes Individual Corporate DirectorBoard Member Jan 1, 2021
Doreen M Hutchinson Individual Corporate OfficerChief Operating/Nursing Officer Sep 30, 2019
W-2 Managing EmployeeChief Operating/Nursing Officer Sep 30, 2019
Jeannette Smith Individual Corporate DirectorDirector Jan 1, 2024
Edith Dobelle Individual Corporate Director Sep 30, 2019
BHS Management Services Inc Organization, Pittsfield, MA Corporation, Management services company, Non-profit, Chain home office Operational/Managerial Control Sep 30, 2019
David Moresi Individual Corporate Director Aug 9, 2022
Lisa Lescarbeau Individual Corporate OfficerClerk of Board of Directors Jan 1, 2025
Anakatina Cordon Suffish Individual Corporate Director Aug 9, 2022
Anthony Scibelli Individual W-2 Managing EmployeeVice President of Fairview Hospital Sep 3, 2024
Kathleen M McCormick Individual Corporate DirectorDirector Jan 1, 2023
Laurie Moffatt Individual Corporate DirectorDirector Jan 1, 2023
Alec R Belman Individual Corporate Director Oct 1, 2022
Shaun V. Cusson Individual Corporate DirectorDirector Jan 1, 2024
Albert a Bravo Individual Corporate Director Sep 30, 2019
James Lederer Individual Corporate OfficerChief Medical Officer Jan 13, 2020
Matthew Lauro Individual Corporate DirectorDirector Jan 1, 2025
Berkshire Health System Inc Organization, Pittsfield, MA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 30, 2019 100%
Edmund H Hornstein Individual Corporate Director Sep 30, 2019
Ashley Benson Individual Corporate DirectorDirector Jan 1, 2025
Frederick W Puddester Individual Corporate DirectorDirector Jan 1, 2023
Scott St George Individual Corporate OfficerChief Financial Officer Nov 2, 2020
Richard Alcombright Individual Corporate Director Sep 30, 2019
Jason M Bratcher Individual Corporate DirectorDirector Jan 1, 2025
Robert Cella Individual Corporate Director Sep 30, 2019
Darlene M Rodowicz Individual Corporate OfficerChief Executive Officer Sep 30, 2019

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Fairview HospitalGreat Barrington, MA, CCN 22Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2003
East Mountain MedicalGreat Barrington, MA, CCN 223976 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2019
Williamstown Medical at North AdamsNorth Adams, MA, CCN 223977 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2019

Owned or controlled facilities with NPI records 3

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

  • Fairview Hospital
    • Medicare Defined Swing Bed Hospital Unit
    • Great Barrington, MA
    • NPI 1174689467

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Fairview Hospital

    dba Williamstown Medical at North Adams

    • Rural Health Clinic/Center
    • North Adams, MA
    • NPI 1639737042

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Fairview Hospital

    dba East Mountain Medical

    • Rural Health Clinic/Center
    • Great Barrington, MA
    • NPI 1881252286

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 10

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

Change-of-ownership history 2

DateEventCounterparty
Sep 30, 2019 Change of OwnershipThis provider was the buyer Williamstown MedicalCCN 223803, MA, NPI 1124686530
Sep 30, 2019 Change of OwnershipThis provider was the seller Williamstown MedicalCCN 223978, MA, NPI 1124686530

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1124686530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1728",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012021728",
            "telephone_number": "413-447-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 ADAMS RD",
            "city": "WILLIAMSTOWN",
            "state": "MA",
            "postal_code": "012672930",
            "telephone_number": "413-458-8182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRVIEW HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAIRVIEW HOSPITAL",
        "enumeration_date": "2019-05-31",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "RODOWICZ",
        "authorized_official_first_name": "DARLENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "413-447-3003"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamstown Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Williamstown Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamstown, MA

Sources for this page

Verify at the official NPI Registry.