NPIMap

Organization Active NPI

Ira Davenport Memorial Hospital, Inc.

  • Rural Acute Care Hospital
  • Bath, NY
National Provider Identifier
1306930318
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
IRA DAVENPORT MEMORIAL HOSPITAL, INC.
Practice address
7571 State Route 54
Bath, NY 14810-9504
Phone
(607) 776-8500
Fax
(607) 776-8800
NPI assigned
Oct 3, 2006
Last updated
Dec 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Mr. Jonathan I. Lawrence
Title
President & Chief Executive Officer
Phone
(607) 776-8500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X
General Acute Care Hospital 282N00000X
Rural Acute Care Hospital 282NR1301X Primary

Addresses

Primary practice location

7571 State Route 54
Bath, NY 14810-9504

Mailing address

7571 State Route 54
Bath, NY 14810
Phone (607) 776-8500

Other identifiers 1

IdentifierTypeStateIssuer
00332816MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040303000724 NY Part B Supplier - Clinic/Group Practice 6406743459 Receives reassigned benefits from 56 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bath, NY
O20241121002687 NY Part A Provider - Rural Emergency Hospital (Reh) 6406743459 Practice locations: Bath, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306930318. Details of each certification follow.

Hospital certification: CCN 330800

Legal name
IRA DAVENPORT MEMORIAL HOSPITAL, INC.
Certification status
Active
Provider type (POS)
Hospital – Rural emergency hospital
Participating since
Jan 2, 2025
Last certification
Dec 4, 2025
Beds
1
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
7571 State Route 54
Bath, NY 14810-9504
Other Hospital Practice Location

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ira Davenport Memorial HospitalCCN 330800 · All quality measures
Type
Rural Emergency Hospital
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Addison Primary Care CL9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

226 W Morris St
Bath, NY 14810
Phone (607) 776-8700

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jack Wheeler Individual Corporate DirectorDirector - Board Member May 24, 2017 11.11%
Jeff B Streeter Individual Corporate DirectorDirector - Board Member Nov 23, 2022 11.11%
Belinda F. Hoad Individual Corporate DirectorDirector - Board Member Nov 23, 2022 11.11%
Jonathan I Lawrence Individual Corporate OfficerPresident & Chief Executive Officer Jul 1, 2018 11.11%
W-2 Managing EmployeePresident & Chief Executive Officer Jul 1, 2018
Jasmine Canestaro Individual W-2 Managing EmployeeAd; Apr 28, 2025
Jo F. Miller Individual Corporate DirectorDirector - Board Member Nov 23, 2022 11.11%
Arnot Ogden Medical Center Organization, Elmira, NY Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Bernard Burns Individual Corporate DirectorDirector - Board Member Mar 19, 2003 11.11%
Kathryn Muller Individual Corporate DirectorDirector - Board Member May 23, 2016 11.11%
Rebecca Gould Individual Corporate OfficerChief Financial Officer Jul 1, 2025
Werner K Brammer Individual Corporate DirectorDirector - Board Chair Mar 26, 2008 11.11%
Joseph F Meade Individual Corporate DirectorDirector - Board Member May 22, 2013 11.11%

Owners & managing parties with NPI records 5

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 69

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 69

Affiliated clinicians 129

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

View all 129

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1306930318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "14810",
            "telephone_number": "607-776-8500",
            "fax_number": "607-776-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148109504",
            "telephone_number": "607-776-8500",
            "fax_number": "607-776-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA DAVENPORT MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "607-776-8500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00332816",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bath, NY

Sources for this page

Verify at the official NPI Registry.