Pontiac Nursing Home LLC

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

Legal business name

PONTIAC NURSING HOME LLC

Practice address

303 E River Rd
Oswego, NY 13126-6400

Phone

(315) 343-1900

Fax

(315) 343-1821

NPI assigned

Oct 19, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Theresa L Moshier, ASST. ADMINISTRATOR

Title

Asst. Adminstrator

Phone

(315) 343-1800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417946732. Details of each certification follow.

• CCN 335590001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335590001

Legal name

PONTIAC NURSING HOME LLC

Organization structure

LLCProprietary

Incorporated

Jan 1, 2000 in NY

Enrollment address

303 E River Rd
Oswego, NY 13126-6400

Nursing home name

PONTIAC NURSING HOME

All disclosed owners & managing parties 5

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

Owners & managing parties with NPI records 2

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

• Jeffrey D Amidon, D.O.

  • Internal Medicine Physician
  • Rome, NY
  • NPI 1457492688

  Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

  CMS ownership
• Charles L Knoll, MD

  • Urology Physician
  • New York, NY
  • NPI 1932123486

  5% Or Greater Direct Ownership Interest, General Partnership Interest

  CMS ownership

Practitioners 2

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.

• Jeffrey D Amidon, D.O.

  • Internal Medicine Physician
  • Rome, NY
  • NPI 1457492688
  NPD (past)
• Michael J Brodowski, M.D.

  • Internal Medicine Physician
  • East Syracuse, NY
  • NPI 1902896012
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417946732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E RIVER RD",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131266400",
            "telephone_number": "315-343-1900",
            "fax_number": "315-343-1821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E RIVER RD",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131266400",
            "telephone_number": "315-343-1900",
            "fax_number": "315-343-1821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTIAC NURSING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOSHIER",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ASST. ADMINSTRATOR",
        "authorized_official_telephone_number": "315-343-1800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ASST. ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308365",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel G. Pisacano, O.D.
• Alyssa Rovere Pitonzo
• Elmer F Plantz Jr., NNP
• Podiatry Services of Central New York, PC
• Kathleen F Pollard, LMSW
• Port City Chiropractic, PC
• Port City Emergency Physicians LLP
• Port City ENT and Allergy Care P C
• Port City Family Medicine P.C. Inc
• Port City Psychotherapy and Psychological Services

• Pediatric Skilled Nursing Facility in Oswego, NY
• Providers in Oswego, NY by specialty
• Pediatric Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.