NPIMap

Organization Active NPI

Rome Memorial Hospital, Inc

  • Primary Care Clinic/Center
  • Boonville, NY
National Provider Identifier
1336100767
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ROME MEMORIAL HOSPITAL, INC
Practice address
13407 State Route 12
Boonville, NY 13309-4954
Phone
(315) 942-3500
Fax
(315) 942-2044
NPI assigned
Mar 28, 2006
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Ann Marie Czyz
Title
President/Ceo
Phone
(315) 337-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

13407 State Route 12
Boonville, NY 13309-4954

Mailing address

245 Avery LN
Rome, NY 13441-4237
Phone (315) 337-1200

Other identifiers 1

IdentifierTypeStateIssuer
03001425MedicaidNY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336100767. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Dec 23, 1994 in NY
Enrollment address
1500N James St
Rome, NY 13440-2844
Other Hospital Practice Location
Hospital subgroups
Psychiatric, Rehabilitation, Short-term

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Rome Memorial Hospital, IncCCN 330215 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
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
Rome Memorial Hospital Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

13407 State Route 12
Boonville, NY 13309
Phone (315) 942-3500

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lynn Reese Individual Corporate DirectorVice Chair Dec 12, 2007
Ryan Thompson Individual Corporate DirectorChief Operations Officer Mar 15, 2020
Anne Marie Czyz Individual Corporate DirectorChief Executive Officer Mar 1, 2021
Valerie Finster Individual Corporate DirectorDirector Patient Accounts Nov 1, 2021
Julie Grow Denton Individual Corporate DirectorTreasurer Jan 11, 2011
Ankur M Desai Individual Corporate OfficerChairman Jan 1, 2020
Kristin Grunder Individual Corporate DirectorAssistant Secretary Oct 24, 2017
Ryan O-Shaughnessy Individual Corporate DirectorAssisstant Treasurer Aug 29, 2017
Darlene Burns Individual Corporate DirectorSecretary Mar 29, 2016
John R Restivo Individual Corporate Officer Jan 1, 2020
Nathan Smith Individual Corporate DirectorAvp Finance Jul 1, 2025 5%
W-2 Managing EmployeeAvp Finance Jul 1, 2025
Operational/Managerial ControlAvp Finance Jul 1, 2025

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 337

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

View all 337

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1336100767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 AVERY LN",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134414237",
            "telephone_number": "315-337-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13407 STATE ROUTE 12",
            "city": "BOONVILLE",
            "state": "NY",
            "postal_code": "133094954",
            "telephone_number": "315-942-3500",
            "fax_number": "315-942-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROME MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "CZYZ",
        "authorized_official_first_name": "ANN MARIE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "315-337-1200"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03001425",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonville, NY

Sources for this page

Verify at the official NPI Registry.