NPIMap

Organization Active NPI

Masonicare Health Center

  • Skilled Nursing Facility
  • Wallingford, CT
National Provider Identifier
1265425136
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
119C Issued in CT
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 Nov 5, 2019

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
Skilled Nursing Facility 314000000X 119C CT 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 2

IdentifierTypeStateIssuer
082OtherCTBLUE CROSS
000001198MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060207000489 CT Part A Provider - Skilled Nursing Facility 4688655541 Practice locations: Wallingford, CT

Skilled nursing facility certification: CCN 075135

Legal name
MASONICARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Dec 9, 2024
Beds
366 (336 certified)
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 1, 1984 in CT
Enrollment address
22 Masonic Ave
Wallingford, CT 06492-3048
Nursing home name
MASONICARE HEALTH CENTER

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: Nursing home

Medicare Care Compare
Listed as
Masonicare Health CenterCCN 075135
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
260232.3 residents per day on average
Penalties (3 years)
1Fines totaling $13,085

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Opthalmology Department5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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 Oct 12, 2020
W-2 Managing EmployeeCfo & Assistant Treasurer Oct 12, 2020
Christopher Earle Individual Corporate OfficerVice Chair Jan 5, 2022
Robert F Polito Individual Corporate OfficerChair Jan 5, 2022
Patrick Birney Individual Corporate OfficerSecretary Jan 5, 2022
Jon-Paul Venoit Individual Corporate DirectorPresident,Ceo, Assistant Secretary Nov 6, 2018
W-2 Managing EmployeePresident,Ceo, Assistant Secretary Jan 1, 2014
Operational/Managerial ControlPresident,Ceo, Assistant Secretary Oct 1, 2016
Newton Buckner Individual Corporate DirectorTreasurer Nov 6, 2018
Courtney Wood Individual W-2 Managing EmployeeLong Term Care Administrator Sep 1, 2020
Masonicare Inc Organization, Wallingford, CT Operational/Managerial Control Oct 1, 1995

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 16

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

View all 16

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": "1572912000000",
    "number": "1265425136",
    "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": "2019-11-05",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "119C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "082",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001198",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.