NPIMap

Organization Active NPI

South Shore University Hospital

  • Psychiatric Hospital Unit
  • Bay Shore, NY
National Provider Identifier
1366450298
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
5154000H Issued in NY
Legal business name
SOUTH SHORE UNIVERSITY HOSPITAL
Practice address
301 E Main St
Bay Shore, NY 11706
Phone
(516) 876-6000
Fax
(516) 876-6600
NPI assigned
Aug 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Mrs. Michele Lee Cusack
Title
Senior Vice President & Cfo
Phone
(516) 321-6058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 5154000H NY Primary

Addresses

Primary practice location

301 E Main St
Bay Shore, NY 11706

Mailing address

972 Brush Hollow Rd FL 5
Westbury, NY 11590-1740
Phone (516) 876-6026

Other names 1

  • Psychiatric Unit Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070507000101 NY Part A Provider - Hospital 7214823764 Practice locations: Bay Shore, NY

Hospital certification: CCN 33S043

Legal name
SOUTH SHORE UNIVERSITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Feb 4, 1913 in NY
Enrollment address
301 E Main St
Bay Shore, NY 11706-8408
Hospital Psychiatric Unit
Hospital subgroups
General, Psychiatric, Rehabilitation

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).

National Provider Directory

National Provider Directory
Tax ID family
Southside Hospital HHA5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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.

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
William L Mack Individual Corporate Director Dec 31, 1998
Margaret M Crotty Individual Corporate OfficerChair-Elect Jan 1, 2021
Northwell, Inc. Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2024 100%
Harry E Gindi Individual Corporate OfficerAssistant Secretary Jan 1, 2020
Richard T Miller Individual Corporate OfficerEvp & Chief Bus Strategy Officer Sep 1, 2017
Jeffrey a Kraut Individual Corporate OfficerEvp Strategy and Analytics Jan 1, 2021
Robert D Rosenthal Individual Corporate OfficerTreasurer Jan 1, 2021
Mark L Claster Individual Corporate Director Dec 31, 1998
Mark J Solazzo Individual Corporate Director Dec 31, 1998
W-2 Managing Employee Dec 31, 1998
William Erik Schachtel Individual W-2 Managing Employee Mar 14, 2016
Richard D Goldstein Individual Corporate Director Dec 31, 1998
Northwell Healthcare Inc Organization, Westbury, NY Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Mar 1, 1994 100%
Operational/Managerial Control Mar 1, 1994
David L Battinelli Individual Corporate OfficerEvp Physician-in-Chief Jan 1, 2020
Kathleen Gallo Individual Corporate OfficerEvp and Chief Learning Officer Jan 1, 2020
Donald Zucker Individual Corporate Director Dec 31, 1998
Barry Rubenstein Individual Corporate Director Dec 31, 1998
Northwell Health Inc Organization, Westbury, NY Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2015 100%
Michael a Epstein Individual Corporate OfficerChair, Board of Trustees Jan 1, 2020
Mark a. Gloade Individual Corporate OfficerSVP Deputy General Counsel Jan 1, 2015
Eugene S Tangney Individual Corporate OfficerSVP Chief Bus Continuity & Crisis Jan 1, 2015
Donna K Drummond Individual Corporate OfficerSVP & Chief Expense Officer Jan 1, 2015
Joseph S Moscola Individual Corporate OfficerEvp Enterprise Management Jan 1, 2021
Michael J Dowling Individual W-2 Managing Employee Apr 1, 2007
Laurence a Kraemer Individual Corporate OfficerSVP & Chief General Counsel Jan 1, 2020
Konstantine Costalas Individual Corporate OfficerSVP Managed Care Jan 1, 2021
Ralph a Nappi Individual Corporate OfficerExecutive Vice Chairman Jan 1, 2015
Michele L Cusack Individual Corporate OfficerSenior Vice President & Cfo Sep 12, 2017
W-2 Managing EmployeeSenior Vice President & Cfo Sep 12, 2017

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 42

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

View all 42

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1366450298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "972 BRUSH HOLLOW RD FL 5",
            "city": "WESTBURY",
            "state": "NY",
            "postal_code": "115901740",
            "telephone_number": "516-876-6026",
            "fax_number": "516-876-5572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 E MAIN ST",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "11706",
            "telephone_number": "516-876-6000",
            "fax_number": "516-876-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE UNIVERSITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "516-321-6058",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NY",
            "license": "5154000H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Psychiatric Unit",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Psychiatric Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bay Shore, NY

Sources for this page

Verify at the official NPI Registry.