NPIMap

Organization Active NPI

Masonicare Health Center

  • Psychiatric Hospital
  • Wallingford, CT
National Provider Identifier
1174516041
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
MASONICARE HEALTH CENTER
Practice address
22 Masonic Ave
Wallingford, CT 06492-3048
Phone
(203) 679-5900
NPI assigned
Aug 25, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Authorized official

Name
Jon-Paul Venoit
Title
President & Ceo
Phone
(203) 679-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

22 Masonic Ave
Wallingford, CT 06492-3048

Mailing address

22 Masonic Ave
Wallingford, CT 06492-3048
Phone (203) 679-5900

Other identifiers 3

IdentifierTypeStateIssuer
000070177MedicaidCT
082OtherCTBLUE CROSS
004025425MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211029000251 CT Part A Provider - Hospital 4688655541 Practice locations: Wallingford, CT

Hospital certification: CCN 074016

Legal name
MASONICARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 10, 2023
Last certification
May 31, 2023
Beds
43
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1984 in CT
Enrollment address
22 Masonic Ave
BLDG Sturges
Wallingford, CT 64923048
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Masonicare Health CenterCCN 074016
Type
Psychiatric
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

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
Steven Beaulieu Individual Corporate OfficerCfo, Assistant Treasurer Aug 1, 2021
W-2 Managing EmployeeCfo, Assistant Treasurer Aug 1, 2021
Christopher Earle Individual Corporate OfficerVice Chair Aug 1, 2021
Robert F Polito Individual Corporate OfficerChair Aug 1, 2021
Janet Berry Individual Corporate OfficerSecretary Aug 1, 2021
Jon-Paul Venoit Individual W-2 Managing EmployeePresident,Ceo, Assistant Secretary Aug 1, 2021
Operational/Managerial ControlPresident,Ceo, Assistant Secretary Aug 1, 2021
Newton Buckner Individual Corporate OfficerTreasurer Aug 1, 2021
Robert Leake Individual Corporate DirectorExecutive Director Hospital SVCS Aug 1, 2021
W-2 Managing EmployeeExecutive Director Hospital SVCS Aug 1, 2021
Masonicare Inc Organization, Wallingford, CT Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 29, 1995 100%

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706227200000",
    "number": "1174516041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MASONIC AVE",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064923048",
            "telephone_number": "203-679-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASONICARE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A",
        "authorized_official_last_name": "VENOIT",
        "authorized_official_first_name": "JON-PAUL",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "203-679-5000"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000070177",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "082",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004025425",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.