Healthalliance Marys Avenue Campus

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

HEALTHALLIANCE MARYS AVENUE CAMPUS

Practice address

105 Mary's Ave
Kingston, NY 12401

Phone

(845) 943-6007

Fax

(845) 943-6038

NPI assigned

Mar 8, 2006

Last updated

Mar 23, 2015By 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

Maureen Schupp

Title

Director, Patient Accounts

Phone

(845) 943-6007

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Benedictine Hospital Former legal business name

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427068800000",
    "number": "1447227491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MARY'S AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-943-6007",
            "fax_number": "845-943-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MARY'S AVE",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-943-6007",
            "fax_number": "845-943-6038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHALLIANCE MARYS AVENUE CAMPUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2015-03-23",
        "status": "A",
        "authorized_official_last_name": "SCHUPP",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_title_or_position": "DIRECTOR, PATIENT ACCOUNTS",
        "authorized_official_telephone_number": "845-943-6007"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00274020",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP PROVIDER ID",
            "identifier": "10005742",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI PROVIDER ID",
            "identifier": "3185",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "000302",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP PROVIDER ID",
            "identifier": "UV5282",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE PROVIDER ID",
            "identifier": "103185",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER ID",
            "identifier": "6450795",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benedictine Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.