Rome Memorial Hospital, Inc
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Rome, NY
NPI 1306807193 · NPPES record last updated Jul 11, 2023
Key facts
- NPI
- 1306807193
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- ROME MEMORIAL HOSPITAL, INC
- Practice address
- 264 W Dominick St
Rome, NY 13440-5812 - Phone
- (315) 334-4701
- Fax
- (315) 334-4267
- NPI assigned
- Mar 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Ann Marie Czyz
- Title
- President/Ceo
- Phone
- (315) 337-1200
Owners & managing parties with NPI records 2
-
Ankur Desai, MD
Other NPIs on the same Medicare enrollment 11
Corporate family (same tax ID) 10
Related certifications (CCN) 1
Practitioners 1
-
Sudershan Kumar Dang, M.D.
Affiliated clinicians 337
-
Nabin Adhikari, MD
-
Mahmoud Ahmed, MD
-
Douglas Ahn, M.D.
-
Domenic P Aiello, MD
-
Waleed Albert, MD
-
Raphael J Alcuri, M.D.
-
Brian C Alessi, MD
-
Diego X Alvarez, MD
-
Leo Ismaila Amodu, M.D., M.P.H.
-
Minela Andelija, RPA-C
-
Tatyana Antonevich, M.D.
-
Jameel H Arastu, M.D.
-
Saif Mohammad Aslam, M.D
-
Parvez Asmat, MD
-
Michael Joseph Attilio, M.D.
-
John Paul Badami, MD
-
Tara Nicole Baier, PA-C, ATC
-
Michelle Baker, MD
-
Barbara Anne Baltzer, MS NP
-
Alexa Barron, FNP-C
-
Denny J Battista, D.O.
-
Reid Daniel Beattie, PA-C
Medicare Care Compare: Hospital
- Listed as
- Rome Memorial Hospital, Inc
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Hospital certification: CCN 330215
- Legal name
- ROME MEMORIAL HOSPITAL, INC.
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Oct 10, 2024
- Beds
- 144
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 23, 1994 in NY
- Enrollment address
- 1500N James St
Rome, NY 13440-2844 - Hospital subgroups
- Psychiatric, Rehabilitation, Short-term
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Lynn Reese |
Corporate Director |
Dec 12, 2007 | |
| Ryan Thompson |
Corporate Director |
Mar 15, 2020 | |
| Anne Marie Czyz |
Corporate Director |
Mar 1, 2021 | |
| Valerie Finster |
Corporate Director |
Nov 1, 2021 | |
| Julie Grow Denton |
Corporate Director |
Jan 11, 2011 | |
| Ankur M Desai |
Corporate Officer |
Jan 1, 2020 | |
| Kristin Grunder |
Corporate Director |
Oct 24, 2017 | |
| Ryan O-Shaughnessy |
Corporate Director |
Aug 29, 2017 | |
| Darlene Burns |
Corporate Director |
Mar 29, 2016 | |
| John R Restivo |
Corporate Officer | Jan 1, 2020 | |
| Nathan Smith |
Corporate Director |
Jul 1, 2025 | 5% |
| W-2 Managing Employee |
Jul 1, 2025 | ||
| Operational/Managerial Control |
Jul 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021021000020 | NY | Part a Provider - Hospital | 9638087273 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Boonville, NY; Camden, NY; Rome, NY |
| O20040719001470 | NY | Part B Supplier - Clinic/Group Practice | 9638087273 |
Receives reassigned benefits from 56 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Camden, NY; Rome, NY; Boonville, NY |
National Provider Directory
- Tax ID family
- Rome Memorial Hospital Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
264 W Dominick St
Rome, NY 13440-5812
Mailing address
1500 N James St
Rome, NY 13440-2844
Phone (315) 337-1200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03001416 | Medicaid | NY |
Other providers in Rome, NY
- Rome Medical Practice P.C.
- Rome Medical Practice PC
- Rome Medical Practice PC
- Rome Memorial Hospital
- Rome Memorial Hospital, Inc
- Rome Memorial Hospital, Inc
- Rome Memorial Hospital, Inc
- Rome Memorial Hospital, Inc
- Rome Memorial Hospital, Inc
- Rome Memorial Hospital, Inc.
All providers in Rome, NY · Substance Use Disorder Rehabilitation Clinic/Center in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.