NPIMap

Organization Active NPI

St Johns Health Care Corporation

Doing business as St. John's Home

  • Skilled Nursing Facility
  • Rochester, NY
National Provider Identifier
1164425971
Registry record updated Jan 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ST JOHNS HEALTH CARE CORPORATION
Doing business as
St. John's Home
Practice address
150 Highland Avenue
Rochester, NY 14620
Phone
(585) 760-1300
Fax
(585) 760-1497
NPI assigned
May 24, 2005
Last updated
Jan 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2016

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

Authorized official

Name
Mrs. Mary G Russo, CPA
Title
Director of Finance
Phone
(585) 760-1421

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

150 Highland Avenue
Rochester, NY 14620

Mailing address

150 Highland Avenue
Rochester, NY 14620
Phone (585) 760-1300

Other names 1

  • St. John's Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070810000184 NY Part B Supplier - Clinic/Group Practice 2264523893 Receives reassigned benefits from 10 practitioners
Practice locations: Rochester, NY
O20071004000213 NY Part A Provider - Skilled Nursing Facility 2264523893 Practice locations: Rochester, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164425971. Details of each certification follow.

Skilled nursing facility certification: CCN 335008

Legal name
ST JOHNS HEALTH CARE CORPORATION
Doing business as
ST. JOHN'S NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 19, 1972
Last certification
Jun 9, 2025
Beds
455
Ownership / control type
Corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 1997 in NY
Enrollment address
150 Highland Ave
Rochester, NY 14620-3024
Nursing home name
ST. JOHN'S HEALTH CARE CORPORATION

Care Compare: Nursing home

Medicare Care Compare
Listed as
St. John's Health Care CorporationCCN 335008 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 19, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
455337.7 residents per day on average
Penalties (3 years)
2Fines totaling $141,034

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0173383St John's Health Care Corp Dba St John's Home150 Highland Ave, Rochester, NY 14620Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

1 Johnsarbor Dr W
Rochester, NY 14620
Phone (585) 532-7214

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
William Wallace Individual Corporate Director Jun 30, 2021
Robert Boehner Individual Corporate Director Sep 25, 2007
Ghinwa K Dumyati Individual Corporate Director Jun 30, 2021
Ray Pettine Individual Corporate Director Jun 30, 2021
St Johns Health Care Corporation Organization, Rochester, NY Corporation Operational/Managerial Control Oct 2, 2007
Helen Halewski Individual Corporate Director Jun 30, 2021
Charles Runyon Individual Corporate OfficerChief Executive Officer Feb 1, 1993
W-2 Managing EmployeeChief Executive Officer Feb 1, 1993
Bridget Shumway Individual Corporate Director Sep 25, 2007

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1164425971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HIGHLAND AVENUE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14620",
            "telephone_number": "585-760-1300",
            "fax_number": "585-760-1497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 HIGHLAND AVENUE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14620",
            "telephone_number": "585-760-1300",
            "fax_number": "585-760-1497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHNS HEALTH CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "585-760-1421",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.