NPIMap

Organization Active NPI

Athol Memorial Hospital Incorporated

  • Critical Access Hospital
  • Athol, MA
National Provider Identifier
1336120047
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2226 Issued in MA
Legal business name
ATHOL MEMORIAL HOSPITAL INCORPORATED
Practice address
2033 Main Street
Athol, MA 01331
Phone
(978) 249-3511
Fax
(978) 249-2651
NPI assigned
Nov 9, 2005
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
HEYWOOD HEALTHCARE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Thomas J Sullivan
Title
Ceo
Phone
(978) 630-6157

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2036 MA
Family Medicine Physician 207Q00000X 2036 MA
Cardiovascular Disease Physician 207RC0000X 2036 MA
Forensic Psychiatry Physician 2084F0202X 2036 MA
Geriatric Psychiatry Physician 2084P0805X 2036 MA
Body Imaging Physician 2085B0100X 2036 MA
Medical Specialty Clinic/Center 261QM2500X 2226 MA
General Acute Care Hospital 282N00000X 2036 MA
Critical Access Hospital 282NC0060X 050 MA
Critical Access Hospital 282NC0060X 2226 MA Primary
Physician Assistant 363A00000X 2036 MA
Nurse Practitioner 363L00000X 2036 MA
Acute Care Nurse Practitioner 363LA2100X 2036 MA
Family Nurse Practitioner 363LF0000X 2036 MA

Addresses

Primary practice location

2033 Main Street
Athol, MA 01331

Mailing address

242 Green St
Gardner, MA 01440-1336
Phone (978) 632-3420

Other identifiers 8

IdentifierTypeStateIssuer
110024479CMedicaidMA
1002244MedicaidMA
22Z303OtherMAMCRSWING BED
2222000301OtherMABCBS OF MA INPATIENT
2222000310OtherMABCBS OF MA OUTPATIENT
22Z303OtherMAMEDICARE SWING BED
110024479BMedicaidMA
1200127MedicaidMA

Other names 1

  • Athol Memorial Hospital Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050218000228 MA Part B Supplier - Clinic/Group Practice 7911959846 Receives reassigned benefits from 360 practitioners
Practice locations: Athol, MA
O20051116000033 MA Part A Provider - Critical Access Hospital 7911959846 Receives reassigned benefits from 47 practitioners
Practice locations: Athol, MA
O20210831002259 MA Part A Provider - Critical Access Hospital 7911959846 Practice locations: Athol, MA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1336120047. Details of each certification follow.

Hospital certification: CCN 221303

Legal name
ATHOL MEMORIAL HOSPITAL INCORPORATED
Doing business as
ATHOL MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2005
Last certification
Jul 9, 2015
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1918 in MA
Enrollment address
2033 Main Street
Athol, MA 1331

Hospital certification: CCN 22Z303

Legal name
ATHOL MEMORIAL HOSPITAL INCORPORATED
Doing business as
ATHOL MEMORIAL HOSPITAL
Organization structure
CorporationProprietary
Incorporated
Jan 1, 1983 in MA
Enrollment address
2033 Main Street Athol
Athol, MA 13313535
Other Hospital Practice Location

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Athol Memorial HospitalCCN 221303 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

80 Mechanic St
Athol, MA 01331
Phone (978) 249-7818

80 Mechanic St
Ste 62
Athol, MA 01331

81 Reservoir Dr
#A
Athol, MA 01331

450 W River St
Ste 5
Orange, MA 01364

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Craig S Twohey Individual Corporate Director Feb 1, 2015
Corporate Director Feb 1, 2012
Joanne a Parks Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Erin C O'Hara Individual Corporate Director Jan 1, 2022
Debra L Vescovi Individual Corporate Director Jan 23, 2019
Albert S Rose Individual Corporate Director Jan 25, 2018
Kenneth J Pierce Individual Corporate Director Dec 31, 2012
Corporate DirectorChairman Dec 31, 2012
Michael Abbatiello Individual W-2 Managing EmployeeCfo/VP of Finance Jan 18, 2020
John Bujak Individual Corporate OfficerCfo Feb 4, 2024
David Spackman Individual Corporate Director May 30, 2019
Roy V Lake Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Heywood Healthcare Inc Organization, Gardner, MA Non-profit Operational/Managerial Control Sep 6, 2013
Operational/Managerial Control Dec 31, 2012 100%
Tina M Sbrega Individual Corporate Director Dec 31, 2012
Corporate DirectorClerk Dec 31, 2012
Cheney M Castine Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Glenn a Hunt Individual Corporate Director Dec 31, 2012
Corporate DirectorVice Chairman Dec 31, 2012
John M Skrzypczak Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Winfield S Brown Individual Corporate Officer Dec 31, 2012
Corporate Director Dec 31, 2012
W-2 Managing Employee Dec 31, 2012
Robert F Chauvin Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Craig Anthony Napolitano Individual Corporate Director Jan 1, 2021
Michele C Parker Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Joel R Shaughnessy Individual Corporate Director Jan 1, 2013
Corporate Director Dec 31, 2012
Joyce C Fletcher Individual Corporate Director Dec 31, 2012
Corporate DirectorBoard Member Dec 31, 2012
Thomas Sullivan Individual Corporate OfficerCeo Feb 5, 2024
Corporate DirectorCeo Feb 5, 2024
W-2 Managing EmployeeCeo Feb 5, 2024
Elizabeth M Nottleson Individual Corporate Director Dec 1, 2014
James W Meehan Individual Corporate DirectorBoard Member Dec 31, 2012
Benjamin D Prentiss Individual Corporate Director Jan 1, 2017

Owners & managing parties with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 361

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 361

Affiliated clinicians 200

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

View all 200

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1336120047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 GREEN ST",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014401336",
            "telephone_number": "978-632-3420",
            "fax_number": "978-630-6596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 MAIN STREET",
            "city": "ATHOL",
            "state": "MA",
            "postal_code": "01331",
            "telephone_number": "978-249-3511",
            "fax_number": "978-249-2651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHOL MEMORIAL HOSPITAL INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEYWOOD HEALTHCARE INC",
        "enumeration_date": "2005-11-09",
        "last_updated": "2023-06-08",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-630-6157"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MA",
            "license": "2226",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MA",
            "license": "050",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MA",
            "license": "2226",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MA",
            "license": "2036",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "2036",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024479C",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002244",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCRSWING BED",
            "identifier": "22Z303",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MA INPATIENT",
            "identifier": "2222000301",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MA OUTPATIENT",
            "identifier": "2222000310",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SWING BED",
            "identifier": "22Z303",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024479B",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1200127",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athol Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Athol Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Athol, MA

Sources for this page

Verify at the official NPI Registry.