CGSR, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0901303N Issued in NY

Legal business name

CGSR, INC

Doing business as

Meadowbrook Healthcare

Practice address

154 Prospect Ave
Plattsburgh, NY 12901-1302

Phone

(518) 563-5440

Fax

(518) 563-1206

NPI assigned

May 24, 2005

Last updated

Dec 31, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul F. Richards

Title

Administrator

Phone

(518) 563-5440

Specialties & licenses 4

Addresses

Other identifiers 4

Other names 1

• Meadowbrook Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215930292. Details of each certification follow.

• CCN 335438001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335438001

Legal name

CGSR INC

Doing business as

MEADOWBROOK HEALTHCARE

Organization structure

CorporationProprietary

Incorporated

Nov 21, 1994 in NY

Enrollment address

154 Prospect Ave
Plattsburgh, NY 12901-1302

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.

Practitioners 4

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.

• Debra Clark, M.D.

  • Family Medicine Physician
  • Keeseville, NY
  • NPI 1962473397
  Medicare reassignment NPD
• Joshua Michael Korb, APRN

  • Acute Care Nurse Practitioner
  • Plattsburgh, NY
  • NPI 1104594407
  Medicare reassignment NPD
• Kevin McCullum, MD

  • Family Medicine Physician
  • Plattsburgh, NY
  • NPI 1063518975
  Medicare reassignment
• Jason Ford, MD

  • Hospitalist Physician
  • Mineola, NY
  • NPI 1871026708
  NPD (past)

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1215930292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 PROSPECT AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011302",
            "telephone_number": "518-563-5440",
            "fax_number": "518-563-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 PROSPECT AVE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011302",
            "telephone_number": "518-563-5440",
            "fax_number": "518-563-1206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CGSR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "518-563-5440",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "0901303N",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02994732",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS EMPLOYER ID",
            "identifier": "08-41529-7",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PFI",
            "identifier": "0140",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPERATING CERTIFICATE NUM",
            "identifier": "0901303N",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadowbrook Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.