NPIMap

Organization Active NPI

Prime Healthcare Services-Landmark LLC

Doing business as Landmark Medical Center

  • Psychiatric Hospital Unit
  • Woonsocket, RI
National Provider Identifier
1396722666
Registry record updated Feb 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
00117 Issued in RI
Legal business name
PRIME HEALTHCARE SERVICES-LANDMARK LLC
Doing business as
Landmark Medical Center
Practice address
115 Cass Ave
Woonsocket, RI 02895-4705
Phone
(401) 769-4100
Fax
(401) 765-6024
NPI assigned
Dec 28, 2005
Last updated
Feb 18, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
LANDMARK MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2014

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

Authorized official

Name
Richard Charest
Title
President
Phone
(401) 769-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 00117 RI Primary

Addresses

Primary practice location

115 Cass Ave
Woonsocket, RI 02895-4705

Mailing address

196 Cass Ave
Woonsocket, RI 02895-4712
Phone (401) 769-4100

Other identifiers 12

IdentifierTypeStateIssuer
5012812OtherRIUNITED HEALTHCARE
OP00011MedicaidRI
903288OtherMDTUFTS HEALTH PLAN (OP)
0000000010OtherRIBLUE CROSS
7000251MedicaidMA
7029241MedicaidMA
1015600OtherRIBEACON HEALTH STRATEGIES
222921474OtherRITRICARE
H00104OtherRIBLUE CHIP
4100011MedicaidRI
900934OtherMAHARVARD PILGRIM HEALTH
903289OtherMATUFTS HEALTH PLAN (IP)

Other names 1

  • Landmark Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140127000031 RI Part A Provider - Hospital 3274761069 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Smithfield, RI; Woonsocket, RI; Smithfield, RI; Cumberland, RI
O20140131000196 RI Part A Provider - Hospital 3274761069 Practice locations: Woonsocket, RI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1396722666. Details of each certification follow.

Hospital certification: CCN 410011

Legal name
PRIME HEALTHCARE SERVICES LANDMARK LLC
Doing business as
LANDMARK MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 2, 2019
Beds
214
Ownership / control type
Private (not for profit)
Most recent change of ownership
Dec 31, 2013 (4 total)
Organization structure
LLCNon-profit
Incorporated
Oct 12, 2012 in DE
Enrollment address
115 Cass Ave
Woonsocket, RI 28954705
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Hospital certification: CCN 41S011

Legal name
PRIME HEALTHCARE SERVICES LANDMARK LLC
Doing business as
LANDMARK MEDICAL CENTER
Organization structure
LLCNon-profit
Incorporated
Oct 12, 2012 in RI
Enrollment address
115 Cass Ave
Woonsocket, RI 28954705
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

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

Other NPIs with the same Medicare PAC ID 4

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Landmark Medical CenterCCN 410011 · 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
Part of
Prime Healthcare Services-Landmark LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation, For-profit Operational/Managerial Control Jan 1, 2014
5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Steven Aleman Individual Corporate OfficerCorporate Chief Financial Officer Jun 1, 2020
OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Margaret Macek Individual Corporate OfficerChief Nursing Officer Apr 29, 2022
Corporate DirectorDirector Apr 29, 2022
W-2 Managing EmployeeChief Nursing Officer Apr 29, 2022
Michael Souza Individual Corporate OfficerChief Executive Officer Feb 1, 2017
Corporate DirectorDirector Feb 1, 2017
W-2 Managing EmployeeChief Executive Officer Feb 1, 2017
Corporate OfficerChief Executive Officer Apr 29, 2022
Corporate DirectorDirector Apr 29, 2022
W-2 Managing EmployeeChief Executive Officer Apr 29, 2022
Prime Healthcare Foundation Inc Organization, Ontario, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2017 100%
Stanley Balon Individual Corporate DirectorDirector Apr 29, 2022
Shaun Cournoyer Individual Corporate DirectorDirector Apr 29, 2022
Kasp Trust Organization, Victorville, CA 5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%
Prime Healthcare Holdings Inc Organization, Ontario, CA For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rehabilitation Hospital of Rhode IslandNorth Smithfield, RI, CCN 413025 Hospital 5% Or Greater Direct Ownership Interest (40%) Apr 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Affiliated clinicians 187

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

View all 187

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1396722666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 CASS AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954712",
            "telephone_number": "401-769-4100",
            "fax_number": "401-765-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CASS AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954705",
            "telephone_number": "401-769-4100",
            "fax_number": "401-765-6024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES-LANDMARK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LANDMARK MEDICAL CENTER",
        "enumeration_date": "2005-12-28",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "CHAREST",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-769-4100"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "RI",
            "license": "00117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "5012812",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OP00011",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN (OP)",
            "identifier": "903288",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0000000010",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000251",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7029241",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH STRATEGIES",
            "identifier": "1015600",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "222921474",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "H00104",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4100011",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH",
            "identifier": "900934",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN (IP)",
            "identifier": "903289",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Landmark Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woonsocket, RI

Sources for this page

Verify at the official NPI Registry.