NPIMap

Organization Active NPI

Elizabethtown Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Elizabethtown, NY
National Provider Identifier
1407061591
Registry record updated Feb 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
ELIZABETHTOWN COMMUNITY HOSPITAL
Practice address
75 Park St
Elizabethtown, NY 12932-2300
Phone
(518) 873-6377
Fax
(518) 873-2315
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2024

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

Authorized official

Name
Mr. John R. Remillard
Title
President
Phone
(518) 873-3002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

75 Park St
Elizabethtown, NY 12932-2300

Mailing address

75 Park St
Elizabethtown, NY 12932
Phone (518) 873-6377

Other identifiers 1

IdentifierTypeStateIssuer
00354274MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220827000145 NY Part A Provider - Critical Access Hospital 3577554138 Receives reassigned benefits from 15 practitioners
Practice locations: Elizabethtown, NY

Hospital certification: CCN 33Z302

Legal name
ELIZABETHTOWN COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 8, 1926 in NY
Enrollment address
75 Park St
Elizabethtown, NY 12932-2300
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).

National Provider Directory

National Provider Directory
Tax ID family
Tara Littlejohn Gonzales MD - Arbor Pediatrics107 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
William Tansey Individual Corporate DirectorBoard Member Jan 1, 2023
Steven Cacchio Individual Corporate DirectorTreasurer Jan 1, 2018
Charles Lender Individual Corporate DirectorBoard Member Jan 1, 2023
Robert P Ortmyer Individual Corporate OfficerPresident Jul 12, 2021
W-2 Managing EmployeePresident Jul 12, 2021
Operational/Managerial ControlPresident Jul 12, 2021
David Shelmidine Individual Corporate DirectorVice Chair Jan 1, 2018
Megan Murphy Individual Corporate DirectorBoard Member Jan 1, 2017
Susan Allott Individual Corporate DirectorChair Jan 1, 2018
Evan George Individual Corporate DirectorSecretary Jan 1, 2020
The University of Vermont Health Network Inc. Organization, Burlington, VT Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 17, 2014 100%
Operational/Managerial Control Nov 17, 2014
Joseph Bogardus Individual Corporate DirectorBoard Member Jan 1, 2023
Terri a Morse Individual Corporate DirectorBoard Member Jan 1, 2021
Elizabeth Elkins Individual W-2 Managing EmployeeEnrollment Specialist II Jan 1, 2023
Alan Jones Individual Corporate DirectorBoard Member Apr 1, 2022
Scott a Comeau Individual Corporate OfficerCfo Jul 25, 2022
W-2 Managing EmployeeCfo Jul 25, 2022
Operational/Managerial ControlCfo Jul 25, 2022
Lynne Reale Individual Corporate DirectorBoard Member Jan 1, 2023

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708128000000",
    "number": "1407061591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "12932",
            "telephone_number": "518-873-6377",
            "fax_number": "518-873-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129322300",
            "telephone_number": "518-873-6377",
            "fax_number": "518-873-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETHTOWN COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2024-02-17",
        "certification_date": "2024-02-17",
        "status": "A",
        "authorized_official_last_name": "REMILLARD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-873-3002",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00354274",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elizabethtown, NY

Sources for this page

Verify at the official NPI Registry.