NPIMap

Organization Active NPI

Hudson Headwaters Health Network

  • Federally Qualified Health Center (FQHC)
  • Glens Falls, NY
National Provider Identifier
1154589083
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
90 South St
Glens Falls, NY 12801-4328
Phone
(518) 792-7841
Fax
(518) 932-0289
NPI assigned
May 28, 2008
Organization subpart
Yes
Parent organization
HUDSON HEADWATERS HEALTH NETWORKAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Laura Pasco
Title
Executive VP, Cfo
Phone
(518) 761-0300

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 27

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

View all 27

Corporate family (same tax ID) 42

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

View all 42

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

Practitioners 12

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

Medicare participation

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

Federally qualified health center certification: CCN 331071

Legal name
HUDSON HEADWATERS HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 6, 2013
Last certification
Aug 6, 2013
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Jul 15, 1981 in NY
Enrollment address
90 South St
Glens Falls, NY 12801-4328
Related CCNs
331854

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Kristina Hermance
Individual 		Corporate Officer
VP, Logistics		 Jul 23, 2023
Stephen T Shafer
Individual 		Corporate Director
Board Member		 Jul 25, 2024
Linda Spokane
Individual 		Corporate Officer
President & Program Director, Pace		 Oct 23, 2017
Tracy Mills
Individual 		Corporate Officer
Executive VP, Network Strategy		 Jan 3, 2022
Vicki Demarse-Giroux
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Kevin Dougrey
Individual 		Corporate Officer
VP, Medical Staff Operations		 Aug 31, 2020
David Tucker Slingerland
Individual 		Corporate Officer
Ceo		 Jun 1, 2014
Laura S Pasco
Individual 		Corporate Officer
Executive VP, Finance & Cfo		 Sep 19, 2022
W-2 Managing Employee
Executive VP, Finance & Cfo		 Jan 14, 2024
Thomas Dodd
Individual 		Corporate Director
Board Member, Vice-Chairperson		 Nov 18, 2021
Jill Coombes
Individual 		Corporate Officer
VP, Compliance, Cco		 Apr 5, 2020
Deana Ketchum
Individual 		Corporate Director
Board Member, at Large Member		 Feb 24, 2022
Jessica Rubin
Individual 		Corporate Officer
VP, Chief Impact Officer		 Apr 5, 2020
Christine a Rowe-Button
Individual 		Corporate Director
Board Member, Secretary		 Nov 18, 2021
James J Morris
Individual 		Corporate Director
Board Member, Treasurer		 Feb 25, 2016
Robert Nemer
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Justin Miller
Individual 		Corporate Officer
Evp, Chief Information Officer		 Jan 15, 2024
Susan Corney
Individual 		Corporate Officer
Executive VP, Human Resources		 Sep 6, 2017
William M Borgos
Individual 		Corporate Officer
Chief Medical Officer		 Oct 1, 2019
Darren Woods
Individual 		Corporate Director
Board Member		 Feb 16, 2023
Matthew Henderson
Individual 		Corporate Officer
Evp, General Counsel		 Dec 29, 2019
Patricia a Auer
Individual 		Corporate Director
Board Member		 Feb 25, 2021
Cathleen Traver
Individual 		Corporate Officer
VP, Planning and Grants		 Sep 18, 2023
Brittany Silvestri
Individual 		Corporate Officer
Evp, Chief Operating Officer		 Aug 8, 2021
Maureen Poole
Individual 		Corporate Officer
VP, Nursing		 Oct 3, 2021
Peter Reale
Individual 		Corporate Director
Board Member		 Feb 25, 2016
Donna Nichols
Individual 		Corporate Director
Board Member, Chairperson		 Jun 28, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031117000239 NY Part B Supplier - Clinic/Group Practice 7416861208 Receives reassigned benefits from 266 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupper Lake, NY; Warrensburg, NY; Ticonderoga, NY; Schroon Lake, NY; Saranac Lake, NY; Salem, NY; Queensbury, NY; Plattsburgh, NY…
O20130801000296 NY Part a Provider - Federally Qualified Health Center (FQHC) 7416861208 Practice locations: Glens Falls, NY

National Provider Directory

Tax ID family
Hudson Headwaters HLTH (43 organizations share this tax ID)
Part of
Hudson Headwaters HLTH

Locations

3767 Main St
Warrensburg, NY 12885
Phone (518) 623-2844

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

90 South St
Glens Falls, NY 12801-4328

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
03013009MedicaidNY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 23, 2024.

{
    "created_epoch": "1211932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1154589083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 SOUTH ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128014328",
            "telephone_number": "518-792-7841",
            "fax_number": "518-932-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2008-05-28",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE VP, CFO",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03013009",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glens Falls, NY

Sources for this page

Verify at the official NPI Registry.