Wyoming County
Organization Active NPI Rural Acute Care Hospital · Warsaw, NY
NPI 1316924913 · NPPES record last updated Apr 15, 2022
Key facts
- NPI
- 1316924913
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Acute Care Hospital 282NR1301X
- License
- 6027000H (NY)
- Legal business name
- WYOMING COUNTY
- Practice address
- 400 N Main St
Warsaw, NY 14569-1025 - Phone
- (585) 786-2233
- Fax
- (585) 786-1222
- NPI assigned
- Dec 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael A. Corcimiglia
- Title
- Coo
- Phone
- (585) 786-8940
Owners & managing parties with NPI records 4
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 4
Member of 1
Facilities with the same owner 1
Practitioners 93
-
Salman Abbasey, M.D.
-
Jeffrey James Brewer, M.D.
-
Renee Casey, NP
-
Gregory James Collins, D.O.
-
David Cooney, PA-C
-
Jacquelyn Janes, FNP
-
Hemant Kalia, MD MPH
-
Lisa Marie Kemp, FNP
-
Mustafa Ali Khan, MD
-
Zachary Tyler Lewis, PA-C
-
Christina Ann Newton, ACNP
-
Angela M Potter, RPA-C
-
Megan K Prusak, FNP
-
Sendhan Amudhan Rajamanickam, MBBS, MRCS, FRCSC
-
Charlene Elizabeth Welsted, AGPCNP-BC
-
Julie Lynn Worthington, PA-C
-
Amy J Yates, NP
-
Steven Dale Arbogast, D.O.
Affiliated clinicians 135
-
Salman Abbasey, M.D.
-
Kathleen Austin, DO
-
Nadine Bailey, MS, PA-C
-
Karen M Baker, NP
-
Gregory Raymond Ball, MD, PH.D
-
Ashley Norell Bartz, RPA-C
-
Ahmed M Bayoumi, M.D.
-
Alberto Carlos Benedicto, M.D.
-
Jeffrey James Brewer, M.D.
-
Debra A Brown, NURSE PRACTITIONER
-
David Brubaker, MD
-
Renee Casey, NP
-
Frank Chen, MD, PHD
-
Gregory James Collins, D.O.
-
David Cooney, PA-C
Medicare Care Compare: Hospital
- Listed as
- Wyoming County
- Type
- Critical Access Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D0938966 | Wyoming County Internal Medicine | Certificate of waiver | Mar 26, 2027 |
| 33D2193429 | Wyoming County Family Medicine - Perry | Certificate of waiver | Mar 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (8 enrollments) in NY
Rural health clinic certification: CCN 333413
- Legal name
- WYOMING COUNTY
- Doing business as
- HEALTHCARE SOLUTIONS WNY , LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 22, 2021
- Last certification
- Feb 22, 2024
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 34 Duncan St
Ste B
Warsaw, NY 14569-1017 - Related CCNs
- 330008
Rural health clinic certification: CCN 338502
- Legal name
- WYOMING COUNTY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 7, 2022
- Last certification
- May 27, 2025
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Incorporated
- Nov 14, 2005 in NY
- Enrollment address
- 1 Parker LN
Perry, NY 14530-9703 - Related CCNs
- 331323
Rural health clinic certification: CCN 333422
- Legal name
- WYOMING COUNTY
- Doing business as
- WYOMING COUNTY FAMILY MEDICINE ARCADE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 14, 2023
- Last certification
- Aug 14, 2023
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Incorporated
- Nov 14, 2005 in NY
- Enrollment address
- 401 Main St
Arcade, NY 14009-1113 - Related CCNs
- 330008
Hospital certification: CCN 331323
- Legal name
- WYOMING COUNTY
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- May 16, 2024
- Last certification
- May 16, 2024
- Beds
- 25
- Ownership / control type
- Local
- Organization structure
- Other · Non-profit
- Enrollment address
- 400 N Main St
Warsaw, NY 14569-1025
Hospital certification: CCN 33Z323
- Legal name
- WYOMING COUNTY
- Organization structure
- Other · Non-profit
- Enrollment address
- 400 N Main St
Warsaw, NY 14569-1025
Hospital certification: CCN 33M323
- Legal name
- WYOMING COUNTY
- Organization structure
- Other · Non-profit
- Enrollment address
- 400 N Main St
Warsaw, NY 14569-1025
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| David a Kobis |
Corporate Officer |
May 31, 2022 | |
| W-2 Managing Employee |
May 31, 2022 | ||
| Mark J Wright |
Corporate Officer |
Jun 6, 2022 | |
| Corporate Officer |
Jun 6, 2022 | 25% | |
| Operational/Managerial Control |
Jun 6, 2022 | ||
| Dawn Bayliss |
W-2 Managing Employee |
Jul 14, 2022 | |
| W-2 Managing Employee |
Jul 17, 2022 | ||
| Wyoming County |
Operational/Managerial Control | May 31, 2022 | |
| 5% Or Greater Direct Ownership Interest | Nov 4, 2005 | 100% | |
| Operational/Managerial Control | Jan 1, 2020 | 100% | |
| 5% Or Greater Direct Ownership Interest | Jan 1, 2020 | 100% | |
| Jeffery R Perry |
Corporate Officer |
Jan 1, 2025 | 50% |
| W-2 Managing Employee |
Jan 1, 2025 | 100% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Med Temps |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Jan 1, 1967 Jan 1, 1967 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040929001076 | NY | Part B Supplier - Clinic/Group Practice | 9335118967 |
Receives reassigned benefits from 89 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Arcade, NY; Attica, NY; Perry, NY; Silver Springs, NY; Warsaw, NY |
| O20201124002505 | NY | Part a Provider - Rural Health Clinic | 9335118967 | Practice locations: Warsaw, NY |
| O20210805003322 | NY | Part a Provider - Rural Health Clinic | 9335118967 | Practice locations: Perry, NY |
| O20210917000765 | NY | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 9335118967 | Practice locations: Mount Morris, NY |
| O20211026003422 | NY | Part a Provider - Rural Health Clinic | 9335118967 | Practice locations: Arcade, NY |
| O20231108001079 | NY | Part a Provider - Critical Access Hospital | 9335118967 |
Receives reassigned benefits from 1 practitioner Practice locations: Warsaw, NY |
| O20240529001015 | NY | Part a Provider - Critical Access Hospital | 9335118967 | Practice locations: Warsaw, NY |
| O20240529001431 | NY | Part a Provider - Critical Access Hospital | 9335118967 | Practice locations: Warsaw, NY |
National Provider Directory
Locations
263 Liberty St
Arcade, NY 14009
Phone (585) 496-5007
5362 Mungers Mill Rd
#A
Silver Springs, NY 14550
Phone 5857868890104
410N Main St
Warsaw, NY 14569
Phone (585) 786-2233
34 Duncan St
Warsaw, NY 14569
Phone (585) 786-2290
34 Duncan St
#B
Warsaw, NY 14569
Phone 58578622904945
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | |||
| Rural Acute Care Hospital | 282NR1301X | 6027000H | NY | Yes |
Addresses
Primary practice location
400 N Main St
Warsaw, NY 14569-1025
Mailing address
400 N Main St
Warsaw, NY 14569-1025
Phone (585) 786-2233
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00310889 | Medicaid | NY | |
| 30 | Other | NY | EXCELLUS BLUE CROSS |
| 000000028000 | Other | NY | BLUE CROSS WESTERN NY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Warsaw | Direct |
Other providers in Warsaw, NY
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
- Wyoming County
All providers in Warsaw, NY · Rural Acute Care Hospital 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 Apr 15, 2022. 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.