NPIMap

Organization Active NPI

Richmond Medical Center

Doing business as Richmond University Medical Center

  • Psychiatric Hospital Unit
  • Staten Island, NY
National Provider Identifier
1184873135
Registry record updated Oct 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
7004010H Issued in NY
Legal business name
RICHMOND MEDICAL CENTER
Doing business as
Richmond University Medical Center
Practice address
355 Bard Ave
Staten Island, NY 10310-1664
Phone
(718) 818-4408
Fax
(718) 818-2743
NPI assigned
Sep 15, 2008
Last updated
Oct 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2018

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

Authorized official

Name
Mr. Robert Ren
Title
VP Finance
Phone
(718) 818-1380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 7004010H NY Primary

Addresses

Primary practice location

355 Bard Ave
Staten Island, NY 10310-1664

Mailing address

355 Bard Ave
Staten Island, NY 10310-1699
Phone (718) 818-4408

Other identifiers 1

IdentifierTypeStateIssuer
00248820MedicaidNY

Other names 1

  • Richmond University Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130128000164 NY Part A Provider - Hospital 8628074994 Practice locations: Staten Island, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184873135. Details of each certification follow.

Hospital certification: CCN 33S028

Legal name
RICHMOND MEDICAL CENTER
Doing business as
RICHMOND UNIVERSITY MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 2006 in NY
Enrollment address
355 Bard Ave
Staten Island, NY 10310-1664
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric 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).

National Provider Directory

National Provider Directory
Tax ID family
Richmond Medical Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1130 South Ave
Staten Island, NY 10314
Phone (718) 818-6132

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
Tony Baker Individual Corporate Director Jan 1, 2007
James Molinaro Individual Corporate Director Jan 1, 2007
Gina Gutzeit Individual Corporate Director Jan 1, 2007
Daniel Messina Individual W-2 Managing Employee Apr 28, 2014
David Murray Individual Corporate OfficerSenior VP, Cfo Jun 1, 2022
Kathryn K Rooney Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 2007

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539820800000",
    "number": "1184873135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101699",
            "telephone_number": "718-818-4408",
            "fax_number": "718-818-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-4408",
            "fax_number": "718-818-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHMOND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-15",
        "last_updated": "2018-10-18",
        "status": "A",
        "authorized_official_last_name": "REN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "718-818-1380",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NY",
            "license": "7004010H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00248820",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richmond University Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.