NPIMap

Organization Active NPI

Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Queensbury, NY
National Provider Identifier
1386657534
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
28 S Western Ave
Queensbury, NY 12804-3323
Phone
(518) 798-6400
Fax
(518) 798-4105
NPI assigned
Aug 15, 2006
Last updated
Feb 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HUDSON HEADWATERS HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Authorized official

Name
Laura Pasco
Title
Executive VP, Cfo
Phone
(518) 761-0300

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NY
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X Primary
Nurse Practitioner 363L00000X NY

Addresses

Primary practice location

28 S Western Ave
Queensbury, NY 12804-3323

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers 1

IdentifierTypeStateIssuer
03289663MedicaidNY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000239 NY Part B Supplier - Clinic/Group Practice 7416861208 Receives reassigned benefits from 266 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupper Lake, NY; Warrensburg, NY; Ticonderoga, NY; Schroon Lake, NY; Saranac Lake, NY; Salem, NY; Queensbury, NY; Plattsburgh, NY…
O20090609000187 NY Part A Provider - Federally Qualified Health Center (FQHC) 7416861208 1 other NPI on this enrollment
Practice locations: Queensbury, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386657534. Details of each certification follow.

Federally qualified health center certification: CCN 331896

Legal name
HUDSON HEADWATERS HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 31, 2000
Last certification
May 31, 2000
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 1981 in NY
Enrollment address
28 S Western Ave
Queensbury, NY 12804-3323

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Hudson Headwaters Healt43 organizations share this tax ID, including this one
Part of
Hudson Headwaters Healt

Other organizations with this tax ID 42

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

View all 42

Locations

828 State Route 11
Champlain, NY 12919
Phone (518) 298-2691

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Kristina Hermance Individual Corporate OfficerVP, Logistics Jul 23, 2023
Stephen T Shafer Individual Corporate DirectorBoard Member Jul 25, 2024
Linda Spokane Individual Corporate OfficerPresident & Program Director, Pace Oct 23, 2017
Tracy Mills Individual Corporate OfficerExecutive VP, Network Strategy Jan 3, 2022
Vicki Demarse-Giroux Individual Corporate DirectorBoard Member Nov 18, 2021
Kevin Dougrey Individual Corporate OfficerVP, Medical Staff Operations Aug 31, 2020
David Tucker Slingerland Individual Corporate OfficerCeo Jun 1, 2014
Laura S Pasco Individual Corporate OfficerExecutive VP, Finance & Cfo Sep 19, 2022
W-2 Managing EmployeeExecutive VP, Finance & Cfo Jan 14, 2024
Thomas Dodd Individual Corporate DirectorBoard Member, Vice-Chairperson Nov 18, 2021
Jill Coombes Individual Corporate OfficerVP, Compliance, Cco Apr 5, 2020
Deana Ketchum Individual Corporate DirectorBoard Member, at Large Member Feb 24, 2022
Jessica Rubin Individual Corporate OfficerVP, Chief Impact Officer Apr 5, 2020
Christine a Rowe-Button Individual Corporate DirectorBoard Member, Secretary Nov 18, 2021
James J Morris Individual Corporate DirectorBoard Member, Treasurer Feb 25, 2016
Robert Nemer Individual Corporate DirectorBoard Member Nov 18, 2021
Justin Miller Individual Corporate OfficerEvp, Chief Information Officer Jan 15, 2024
Susan Corney Individual Corporate OfficerExecutive VP, Human Resources Sep 6, 2017
William M Borgos Individual Corporate OfficerChief Medical Officer Oct 1, 2019
Darren Woods Individual Corporate DirectorBoard Member Feb 16, 2023
Matthew Henderson Individual Corporate OfficerExecutive VP, General Counsel Dec 29, 2019
Patricia a Auer Individual Corporate DirectorBoard Member Feb 25, 2021
Cathleen Traver Individual Corporate OfficerVP, Planning and Grants Sep 18, 2023
Brittany Silvestri Individual Corporate OfficerEvp, Chief Operating Officer Aug 8, 2021
Maureen Poole Individual Corporate OfficerVP, Nursing Oct 3, 2021
Peter Reale Individual Corporate DirectorBoard Member Feb 25, 2016
Donna Nichols Individual Corporate DirectorBoard Member, Chairperson Jun 28, 2018

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1386657534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 S WESTERN AVE",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128043323",
            "telephone_number": "518-798-6400",
            "fax_number": "518-798-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE VP, CFO",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03289663",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Queensbury, NY

Sources for this page

Verify at the official NPI Registry.