NPIMap

Organization Active NPI

Hospice of Jefferson County, Inc.

  • Community Based Hospice Care Agency
  • Watertown, NY
National Provider Identifier
1164426433
Registry record updated Sep 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2201501F Issued in NY
Legal business name
HOSPICE OF JEFFERSON COUNTY, INC.
Practice address
1398 Gotham Street
Watertown, NY 13601
Phone
(315) 788-7323
Fax
(315) 788-9653
NPI assigned
Jun 2, 2005
Last updated
Sep 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2023

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

Authorized official

Name
Anna Patterson
Title
Ceo
Phone
(315) 788-7323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2201501F NY Primary

Addresses

Primary practice location

1398 Gotham Street
Watertown, NY 13601

Mailing address

1398 Gotham Street
Watertown, NY 13601
Phone (315) 788-7323

Other identifiers 1

IdentifierTypeStateIssuer
00987279MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000183 NY Part A Provider - Hospice 1153235932 Practice locations: Watertown, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164426433. Details of each certification follow.

Hospice certification: CCN 331515

Legal name
HOSPICE OF JEFFERSON COUNTY, INC
Doing business as
HOSPICE OF JEFFERSON COUNTY/PALLIATIVE CARE OF JEFFERSON COUNTY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 24, 1986
Last certification
Apr 20, 2021
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
May 7, 1986 in NY
Enrollment address
1398 Gotham St
Watertown, NY 13601-9704

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Jefferson Co/Palliative Care of JeffersCCN 331515 · All quality measures
Ownership
Non-Profit
Certified
Oct 24, 1986
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Sidney Pond Individual Corporate OfficerTreasurer Nov 18, 2024
Corporate Director Mar 1, 2022
Laurie Hulbert Individual Contracted Managing EmployeeAccountant Apr 1, 2024
Anna Patterson Individual Corporate DirectorCeo Aug 2, 2023
W-2 Managing EmployeeCeo Aug 2, 2023
Stephen Grybowski Individual W-2 Managing EmployeeMD;Medical Administrator Nov 29, 2023
Kathleen Zeltmann Individual W-2 Managing EmployeePatient Services/ Compliance Dir Dec 4, 2023
Jeff Wood Individual Corporate OfficerBoard President Nov 18, 2024
Corporate Director Dec 1, 2020

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695340800000",
    "number": "1164426433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1398 GOTHAM STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-788-7323",
            "fax_number": "315-788-9653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1398 GOTHAM STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "13601",
            "telephone_number": "315-788-7323",
            "fax_number": "315-788-9653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF JEFFERSON COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-02",
        "last_updated": "2023-09-22",
        "certification_date": "2023-09-22",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-788-7323"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NY",
            "license": "2201501F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00987279",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.