NPIMap

Organization Active NPI

Healthalliance Hospital Marys Avenue Campus

Doing business as Health Alliance Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kingston, NY
National Provider Identifier
1215989041
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS
Doing business as
Health Alliance Dialysis
Practice address
37 Albany Avenue
Kingston, NY 12401-2902
Phone
(845) 943-6023
Fax
(845) 943-6077
NPI assigned
May 17, 2006
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Mr. Patrick Baker
Title
Avp, Revenue Cycle
Phone
(914) 493-2846

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary
General Acute Care Hospital 282N00000X NU

Addresses

Primary practice location

37 Albany Avenue
Kingston, NY 12401-2902

Mailing address

105 Marys Ave
Kingston, NY 12401-5829
Phone (845) 943-6023

Other identifiers 2

IdentifierTypeStateIssuer
03000204MedicaidNY
00274048MedicaidNY

Other names 1

  • Health Alliance Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210803002810 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 5597665844 Practice locations: Kingston, NY

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: Dialysis facility

Medicare Care Compare
Listed as
Kingston Hospital Dialysis Center- SatelliteCCN 333548
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Jan 1, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
30

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Part of
Benedictine Hospital

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1215989041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MARYS AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124015829",
            "telephone_number": "845-943-6023",
            "fax_number": "845-943-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 ALBANY AVENUE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012902",
            "telephone_number": "845-943-6023",
            "fax_number": "845-943-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTHALLIANCE HOSPITAL MARYS AVENUE CAMPUS",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "AVP, REVENUE CYCLE",
        "authorized_official_telephone_number": "914-493-2846",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03000204",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274048",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Alliance Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingston, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.