NPIMap

Organization Active NPI

Kenmore Mercy Hospital

  • Rehabilitation Hospital Unit
  • Kenmore, NY
National Provider Identifier
1164436283
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
1404030H Issued in NY
Legal business name
KENMORE MERCY HOSPITAL
Practice address
2950 Elmwood Ave
Kenmore, NY 14217-1304
Phone
(716) 447-6100
NPI assigned
Jul 27, 2006
Last updated
Aug 26, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KENMORE MERCY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Authorized official

Name
David P Macholz
Title
Cfo
Phone
(716) 601-3690

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 1404030H NY Primary

Addresses

Primary practice location

2950 Elmwood Ave
Kenmore, NY 14217-1304

Mailing address

2950 Elmwood Ave
Kenmore, NY 14217-1304
Phone (716) 447-6100

Other identifiers 5

IdentifierTypeStateIssuer
00011412501OtherNYUNIVERA
00354343MedicaidNY
040401000067OtherNYFIDELIS
041OtherNYBLUE CROSS OF WNY
10OtherNYINDEPENDENT HEALTH

Other names 1

  • Kenmore Mercy Hospital Rehabilitation Unit Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319000138 NY Part B Supplier - Clinic/Group Practice 7517870462 Receives reassigned benefits from 352 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenmore, NY
O20081112000297 NY Part A Provider - Hospital 7517870462 Practice locations: Kenmore, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164436283. Details of each certification follow.

Hospital certification: CCN 33T102

Legal name
KENMORE MERCY HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
2950 Elmwood Ave
Kenmore, NY 14217-1304
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Kenmore Mercy HospitalCCN 33T102 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 1994

National Provider Directory

National Provider Directory
Tax ID family
Kenmore Mercy Family PH3 organizations share this tax ID, including this one
Part of
Kenmore Mercy Family PH

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
David P Macholz Individual Corporate DirectorChief Financial Officer Jun 19, 2014
Alexis Agnello Individual Corporate DirectorBoard Member Jan 1, 2020
Georgiana Ford Individual Corporate DirectorBoard Member Jan 1, 2020
Kevin Keenan Individual Corporate DirectorBoard Member Jan 1, 2020
Robert E Zapfel Individual Corporate DirectorBoard Member Jun 19, 2014
Russell Edwards Individual Corporate DirectorBoard Member Jan 1, 2020
W-2 Managing Employee Jan 1, 2020
Katherine Vanderhorst Individual Corporate DirectorBoard Member Jan 1, 2020
Michael S Gough Individual Corporate DirectorBoard Member Jan 1, 2020
Leonardo Sette-Camara Individual Corporate DirectorBoard Member Jan 1, 2020
Ellen E Grant Individual Corporate DirectorBoard Member Jan 1, 2020
Mark Sullivan Individual Corporate DirectorBoard Member Jun 19, 2014
Carol Heckman Individual Corporate DirectorBoard Member Jan 1, 2020
Thomas Gleason Individual Corporate DirectorBoard Member Jan 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.

Practitioners & affiliated clinicians

Practitioners 99

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 99

Affiliated clinicians 6

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": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1164436283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 ELMWOOD AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142171304",
            "telephone_number": "716-447-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 ELMWOOD AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142171304",
            "telephone_number": "716-447-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENMORE MERCY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENMORE MERCY HOSPITAL",
        "enumeration_date": "2006-07-27",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "MACHOLZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "716-601-3690"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NY",
            "license": "1404030H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00011412501",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354343",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIDELIS",
            "identifier": "040401000067",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF WNY",
            "identifier": "041",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "10",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenmore Mercy Hospital Rehabilitation Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kenmore, NY

Sources for this page

Verify at the official NPI Registry.