NPIMap

Organization Active NPI

Soldiers & Sailors Memorial Hospital

  • Critical Access Hospital
  • Penn Yan, NY
National Provider Identifier
1215044516
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Practice address
418 N Main St
Penn Yan, NY 14527-1085
Phone
(315) 787-4150
Fax
(315) 787-4794
NPI assigned
Aug 23, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Pamela E Johnson
Title
Treasurer/Cfo
Phone
(315) 787-4031

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary
Paramedic 146L00000X EIN NY

Addresses

Primary practice location

418 N Main St
Penn Yan, NY 14527-1085

Mailing address

418 N Main St
Penn Yan, NY 14527-1085
Phone (315) 787-4150

Other identifiers 5

IdentifierTypeStateIssuer
00336498MedicaidNY
014005017OtherNYBLUE CHOICE OUTPATIENT
10018CFOtherNYPREFERRED CARE ACUTE
012005017OtherNYBLUE CHOICE INPATIENT
17OtherNYBLUE CROSS ACUTE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20200408001326 NY Part A Provider - Rural Health Clinic 0446164255 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Penn Yan, NY
O20201118002718 NY Part A Provider - Rural Health Clinic 0446164255 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Seneca Falls, NY
O20201125001053 NY Part A Provider - Rural Health Clinic 0446164255 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waterloo, NY
O20210407000450 NY Part A Provider - Critical Access Hospital 0446164255 Receives reassigned benefits from 128 practitioners
1 other NPI on this enrollment
Practice locations: Waterloo, NY; Seneca Falls, NY; Penn Yan, NY; Dundee, NY

NPI to CCN mapping 4

The Medicare certification numbers (CCNs) connected to NPI 1215044516. Details of each certification follow.

Rural health clinic certification: CCN 333415

Legal name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 24, 2021
Last certification
Feb 7, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1942 in NY
Enrollment address
418 N Main St
Penn Yan, NY 14527-1070
Related CCNs
331314

Rural health clinic certification: CCN 333416

Legal name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 29, 2021
Last certification
Feb 7, 2024
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1942 in NY
Enrollment address
1991 Balsley Rd
Seneca Falls, NY 13148-6725
Related CCNs
331314

Rural health clinic certification: CCN 338504

Legal name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 20, 2023
Last certification
Jun 20, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1942 in NY
Enrollment address
367A E Main St
Waterloo, NY 13165-1662
Related CCNs
331314

Hospital certification: CCN 331314

Legal name
SOLDIERS & SAILORS MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 13, 2005
Last certification
Apr 15, 2026
Beds
35
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 17, 1916 in NY
Enrollment address
418 N Main St
Penn Yan, NY 14527-1085
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Soldiers and Sailors Memorial Hospital of YatesCCN 331314 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: kevinbrazill@flhealth.medalliesdirect.net

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Kathi S Finizio Individual Operational/Managerial ControlDir Patient Financial Services Jul 1, 1999
W-2 Managing EmployeeDirector Patient Financial Services Jun 23, 2013
W-2 Managing Employee Jun 23, 2013
Robert D Anderson Individual Corporate Officer Jan 1, 2017
Corporate Director Dec 12, 2016
Craig Densmore Individual Corporate Director Sep 14, 2021
Corporate Director Apr 25, 2018
Chevanne Devaney Individual Corporate Director Sep 14, 2021
Corporate Director Apr 26, 2017
Jose Acevedo Individual Corporate OfficerPresident & Ceo Apr 1, 2010
Corporate Director Apr 1, 2010
Rodolfo Queiroz Individual Corporate Director Sep 14, 2021
James Cheney Individual Corporate Director Sep 14, 2021
Corporate Director Apr 27, 2016
Ryan Hallings Individual Corporate Director Sep 14, 2021
Corporate Director Apr 24, 2019
James Nardozzi Individual Corporate Director Sep 14, 2021
Scott a Mooney Individual Corporate Director Sep 14, 2021
James Adams Individual Corporate Director Apr 27, 2022
Corporate Director Apr 27, 2011
Susan Stork Individual Corporate Director Sep 14, 2021
Corporate Director Apr 24, 2019
Kylene Abraham Individual Corporate Director Sep 14, 2021
Corporate Director Apr 26, 2017
Thomas Burrall Individual Corporate Director Sep 14, 2021
Corporate Director Apr 25, 2018
Trisha Koczent Individual Corporate Director May 24, 2021
W-2 Managing Employee May 24, 2021
Corporate DirectorCfo and Treasurer May 24, 2021
W-2 Managing Employee Jun 17, 2021
W-2 Managing EmployeeCfo and Treasurer Jun 17, 2021
Ann H McMullen Individual Corporate Director Apr 23, 2014
Lance Ward Individual Corporate Officer Apr 1, 2016
Corporate Director Apr 22, 2015
Phillip Beckley Individual Corporate Officer Jun 23, 2010
Corporate Director Sep 26, 2018
John Sheppard Individual Corporate Director Apr 27, 2016
Thomas Neil Thompson Individual Corporate Director Apr 26, 2017
Matthew C Talbott Individual Corporate Director Apr 1, 2019
Andre Forcier Individual W-2 Managing EmployeeChief Administrative Officer Aug 1, 2015
W-2 Managing Employee Aug 1, 2015
Jeffrey H Morgan Individual Corporate Director Mar 27, 2019
W-2 Managing Employee Mar 27, 2019
John Hicks Individual Corporate Director Apr 24, 2019

Owners & managing parties with NPI records 6

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

Subparts reporting this organization as parent 12

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

Practitioners & affiliated clinicians

Practitioners 132

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 132

Affiliated clinicians 160

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

View all 160

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215044516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "418 N MAIN ST",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271085",
            "telephone_number": "315-787-4150",
            "fax_number": "315-787-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 N MAIN ST",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271085",
            "telephone_number": "315-787-4150",
            "fax_number": "315-787-4794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLDIERS & SAILORS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "TREASURER/CFO",
        "authorized_official_telephone_number": "315-787-4031",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "NY",
            "license": "EIN",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00336498",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE OUTPATIENT",
            "identifier": "014005017",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE ACUTE",
            "identifier": "10018CF",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE INPATIENT",
            "identifier": "012005017",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ACUTE",
            "identifier": "17",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Penn Yan, NY

Sources for this page

Verify at the official NPI Registry.