Chenango Memorial Hospital, Inc.
Organization Active NPI Family Medicine Physician · Norwich, NY
NPI 1467526889 · NPPES record last updated Jan 5, 2022
Key facts
- NPI
- 1467526889
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- CHENANGO MEMORIAL HOSPITAL, INC.
- Practice address
- 179 N Broad St
Norwich, NY 13815-1019 - Phone
- (607) 337-4111
- Fax
- (607) 337-4293
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Drake Lamen, M.D.
- Title
- President & Ceo
- Phone
- (607) 337-4113
Owners & managing parties with NPI records 3
-
Martin Masarech, MD
-
Kurt R Harding, D.O.
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Practitioners 431
-
Kabir Gandhi, M.D.
-
Harvey M Wiener, DO
-
Matthew Thomas Bennett, M.D.
-
Kristen Bishop, ANP-BC
-
Mark Brennan, DO
-
Rudolph A Buckley, M.D.
-
Khalid Rashid Butt, M.D.
-
Sue Ellen Button, ANP
-
Brenda L Carr, FNP-C
-
Pratima Devi Chandrica, CRNA
-
Mitchell Chess, M.D.
-
Sewng Choi, MD
-
Elizabeth Jane Cummings, FNP-C
-
Jodie Marie Howell, M.D.
-
Jeffrey Jee-Kin Hum, FNP-C
-
Sandy Hun, FNP-BC
-
Mark K Jackson, M.D.
-
John Henry Lalor, MD
-
Ali Marhaba, MD
-
Kristen Kay Menard, ANP
Affiliated clinicians 329
-
Minhaz Ahmad, MD
-
Oneeb Ahmad, MD
-
Mahmood A Ahmed, MD
-
Waqar Ahmed, MD
-
Muhammad I Ali, M.D.
-
Tooba Ali, MD
-
Ahmad A Alwan, DO
-
Jeffrey D Amidon, D.O.
-
Rafshan Amin, MD
-
Gil Ignacio Ascunce, M.D.
-
Rasha Aurshiya, MD
-
Albert Avany, MD
-
Gabrielle Aviles, PA
-
Maria Bajwa, MD
-
Edward Balaci, MD
-
Mary L Barr, PA-C
Medicare Care Compare: Hospital
- Listed as
- Chenango Memorial Hospital
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY, PA
Hospital certification: CCN 330033
- Legal name
- CHENANGO MEMORIAL HOSPITAL INC
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jan 9, 2025
- Beds
- 58
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 29, 1910 in NY
- Enrollment address
- 179N Broad St
Norwich, NY 13815-1019 - Hospital subgroups
- General
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Kurt R Harding |
Corporate Director | Jun 3, 2024 | |
| Eric Larsen |
Corporate Director |
Jun 1, 2015 | |
| Rohan S Jayasena |
Corporate Director | Aug 4, 2025 | |
| James Mark Smith |
Corporate Director | Jan 1, 2022 | |
| Shaunastar Hyle |
Corporate Director | Jan 1, 2022 | |
| John M Carrigg |
Corporate Director |
Jun 1, 2015 | |
| Barbara Schindler |
Corporate Director | Apr 1, 2024 | |
| Cecil M Miller |
Contracted Managing Employee | Apr 21, 2025 | |
| Corporate Director | Apr 21, 2025 | ||
| Joseph R Stagliano |
Corporate Director |
Jun 4, 2019 | |
| Elizabeth K Boland |
Corporate Director |
Jan 1, 2018 | |
| Julianne a. Oehlbeck |
Corporate Director |
Jun 4, 2019 | |
| Bruce Erath |
Corporate Director |
Jun 1, 2015 | |
| Luke Hess-Murphy |
Corporate Director | Jun 5, 2023 | |
| Robert Nassar |
Corporate Director |
Jun 1, 2015 | |
| Martin C Masarech |
Corporate Director |
Jun 4, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040225000911 | NY | Part B Supplier - Clinic/Group Practice | 7517853633 |
Receives reassigned benefits from 216 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Norwich, NY; Oxford, NY; Sherburne, NY; Sidney, NY; Syracuse, NY; Vestal, NY; Baldwinsville, NY; Apalachin, NY… |
| O20070212000527 | NY | Part a Provider - Hospital | 7517853633 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sidney, NY; Sherburne, NY; Oxford, NY; Norwich, NY |
| O20240327003753 | PA | Part B Supplier - Clinic/Group Practice | 7517853633 |
Receives reassigned benefits from 3 practitioners Practice locations: Baden, PA; Moosic, PA; South Abington Township, PA; Warminster, PA |
National Provider Directory
Locations
558 Larkfield Rd
East Northport, NY 11731
Phone (631) 446-7459
415 Hooper Rd
Endwell, NY 13760
Phone (607) 754-3863
6 Newton Ave
Norwich, NY 13815
Phone (607) 334-7144
24 Conkey Ave
Norwich, NY 13815
Phone (607) 336-9098
38A Classic St
Sherburne, NY 13460
Phone (607) 674-4495
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | |||
| Dentist |
122300000X | |||
| Allergy & Immunology Physician |
207K00000X | |||
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Geriatric Medicine (Internal Medicine) Physician |
207RG0300X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Body Imaging Physician |
2085B0100X | |||
| Surgery Physician |
208600000X | |||
| Urology Physician |
208800000X | |||
| Hospitalist Physician |
208M00000X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
179 N Broad St
Norwich, NY 13815-1019
Mailing address
179 N Broad St
Norwich, NY 13815-1019
Phone (607) 337-4111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 330033 | Other | NY | MEDICARE ID |
| 0824000H | Other | OPER CERT# |
Other providers in Norwich, NY
- Chenango Memorial Hospital Inc
- Chenango Memorial Hospital Inc
- Chenango Memorial Hospital Inc
- Chenango Memorial Hospital, Inc
- Chenango Memorial Hospital, Inc
- Chenango Therapeutics
- Chenango Valley Adult Enrichment Center
- Chenango Vision Center, Inc.
- Bethann Lee Chrisbacher
- Anthony D Cicoria
All providers in Norwich, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.