NPIMap

Organization Active NPI

St. Mary's Healthcare

  • Rehabilitation Hospital Unit
  • Amsterdam, NY
National Provider Identifier
1427290709
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
ST. MARY'S HEALTHCARE
Practice address
4988 State Highway 30
Amsterdam, NY 12010-7520
Phone
(518) 842-3100
NPI assigned
Apr 1, 2009
Last updated
Dec 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. MARY'S HOSPITAL AT AMSTERDAMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Authorized official

Name
Victor Giulianelli
Title
President/Ceo
Phone
(518) 841-7101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary

Addresses

Primary practice location

4988 State Highway 30
Amsterdam, NY 12010-7520

Mailing address

427 Guy Park Ave
Amsterdam, NY 12010-1054
Phone (518) 841-7434

Other identifiers 1

IdentifierTypeStateIssuer
03162489MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090507000479 NY Part A Provider - Hospital 7618960709 1 other NPI on this enrollment
Practice locations: Amsterdam, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427290709. Details of each certification follow.

Hospital certification: CCN 33T047

Legal name
ST. MARY'S HEALTHCARE
Organization structure
CorporationNon-profit
Incorporated
May 10, 1909 in NY
Enrollment address
4988 State Highway 30
Amsterdam, NY 12010-7520
Hospital Rehabilitation Unit
Hospital subgroups
General

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

Other NPIs with the same Medicare PAC ID 7

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: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
St. Mary's Hospital at AmsterdamCCN 33T047 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
St Marys Hosp Fam HLTH22 organizations share this tax ID, including this one
Part of
St Marys Hosp Fam HLTH

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Jason Packer Individual Corporate Director Jan 1, 2024
Emily T Etzkorn Individual Corporate Director Jan 1, 2024
Mohammad-Reza Ghazi-Moghadam Individual Corporate DirectorBoard Member Nov 1, 2011
Andrew Heck Individual Other Jan 1, 2024
David Santos Individual Corporate Director Jan 1, 2024
Ronald Marsh Individual Corporate DirectorBoard Member Nov 1, 2011
Michael Pepe Individual Corporate DirectorBoard Member Nov 1, 2011
Keith Waters Individual W-2 Managing Employee Apr 1, 2019
Benjamin Ziskin Individual Corporate Director Jan 1, 2024
Mary Anne Heenan Individual Other Jan 1, 2024
John Daly Individual Corporate DirectorBoard Member Nov 1, 2011
Jeffrey Methven Individual Corporate Director Jan 1, 2024
Operational/Managerial Control Jan 1, 2024
Other Jan 1, 2024
Thomas Cichy Individual Corporate DirectorBoard Member Nov 1, 2011

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 1

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.

Affiliated clinicians 2

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": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1427290709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 GUY PARK AVE",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101054",
            "telephone_number": "518-841-7434",
            "fax_number": "518-841-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4988 STATE HIGHWAY 30",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120107520",
            "telephone_number": "518-842-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S HOSPITAL AT AMSTERDAM",
        "enumeration_date": "2009-04-01",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "GIULIANELLI",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "518-841-7101"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03162489",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amsterdam, NY

Sources for this page

Verify at the official NPI Registry.