NPIMap

Organization Active NPI

Massena Hospital Inc

  • Rural Health Clinic/Center
  • Massena, NY
National Provider Identifier
1326765017
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MASSENA HOSPITAL INC
Practice address
271 Andrews St Ste 267
Massena, NY 13662-3401
Phone
(315) 764-0221
NPI assigned
Oct 24, 2022
Organization subpart
Yes
Parent organization
MASSENA HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Authorized official

Name
Kelly J Cicchinelli
Title
SLH VP of Finance
Phone
(315) 261-5102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

271 Andrews St Ste 267
Massena, NY 13662-3401

Mailing address

50 Leroy St
Potsdam, NY 13676-1786
Phone (315) 261-5150

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200826002864 NY Part A Provider - Rural Health Clinic 1456781491 1 other NPI on this enrollment
Practice locations: Massena, NY

Rural health clinic certification: CCN 333999

Legal name
MASSENA HOSPITAL INC
Doing business as
SLHS MASSENA INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 17, 2020
Last certification
Sep 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
271 Andrews St
Ste 267
Massena, NY 13662
Related CCNs
331322

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Massena Hospital Inc

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
Bedros Bakirtzian Individual Corporate DirectorBoard Member Jan 1, 2020
Michael J Cook Individual Corporate DirectorBoard Member Jan 1, 2020
Nichole S Holder Individual Corporate OfficerDirector of Payor Enrollment Jan 21, 2021
Richard O Davis Individual Corporate Director Oct 15, 2025
Glauco Maresca Individual Corporate DirectorBoard Member Jan 1, 2020
Matthew Lebire Individual Corporate Director Oct 15, 2025
Ashley Peggs Individual W-2 Managing Employee Sep 30, 2022
Amy Stark Individual Corporate Director Oct 15, 2025
Howard Glastonbury Individual Corporate OfficerVP Ceo Corporate Finance Jan 21, 2021
Donna McGregor Individual Corporate Director Oct 15, 2025
St Lawrence Health System, Inc. Organization, Potsdam, NY Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Thomas R Crilly Individual Corporate OfficerExecutive VP Cfo Jan 21, 2021

Owners & managing parties with NPI records 2

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 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666569600000",
    "number": "1326765017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786",
            "telephone_number": "315-261-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 ANDREWS ST STE 267",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136623401",
            "telephone_number": "315-764-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSENA HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASSENA HOSPITAL INC",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "CICCHINELLI",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SLH VP OF FINANCE",
        "authorized_official_telephone_number": "315-261-5102"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Massena, NY

Sources for this page

Verify at the official NPI Registry.