NPIMap

Organization Active NPI

Brooks - TLC Hospital System, Inc.

  • Urgent Care Clinic/Center
  • Gowanda, NY
National Provider Identifier
1487738886
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
BROOKS - TLC HOSPITAL SYSTEM, INC.
Practice address
34 Commercial St
Gowanda, NY 14070-1408
Phone
(716) 532-8100
Fax
(716) 241-7365
NPI assigned
Oct 24, 2006
Last updated
Nov 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Authorized official

Name
Ken Morris
Title
Ceo
Phone
(716) 363-7207

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary
General Acute Care Hospital 282N00000X NU

Addresses

Primary practice location

34 Commercial St
Gowanda, NY 14070-1408

Mailing address

529 Central Ave
Dunkirk, NY 14048-2514
Phone (716) 366-1111

Other identifiers 1

IdentifierTypeStateIssuer
00347544MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040512000025 NY Part B Supplier - Clinic/Group Practice 9537158720 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cassadaga, NY; Derby, NY; Dunkirk, NY; Gowanda, NY
O20090513000591 NY Part A Provider - Hospital 9537158720 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gowanda, NY; Dunkirk, NY; Cassadaga, NY; Derby, NY
O20200601001840 NY Part B Supplier - Hospital Department(S) 9537158720 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunkirk, NY; Gowanda, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487738886. Details of each certification follow.

Hospital certification: CCN 330229

Legal name
BROOKS - TLC HOSPITAL SYSTEM, INC.
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 14, 2024
Beds
65
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 14, 1978 in NY
Enrollment address
529 Central Ave
Dunkirk, NY 14048-2514
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Brooks-TLC Hospital System, IncCCN 330229 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

10988 Bennett State Rd
Forestville, NY 14062
Phone (716) 732-7770

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kenneth Morris Individual Corporate OfficerChief Operatig Officer Jan 1, 2021
Operational/Managerial Control Jun 21, 2022
Louis Dipalma Individual Corporate Director May 9, 2008
Kevin Kearns Individual Corporate Director Jan 1, 2021
Christopher Lanski Individual Corporate Director May 9, 2008
James Edward Wild Individual Corporate Director Jan 1, 2019
Mark Andrew Burr Individual Corporate DirectorTrustee Jun 1, 2012
Timothy Cooper Individual Corporate Director Aug 26, 2019
Dana P Anderson Individual Corporate Director Jan 1, 2018
Nathan Aldrich Individual Corporate Director Jan 1, 2021
Christina Jimerson Individual Corporate Director Aug 26, 2019

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 49

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.

View all 49

Affiliated clinicians 266

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

View all 266

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1487738886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 CENTRAL AVE",
            "city": "DUNKIRK",
            "state": "NY",
            "postal_code": "140482514",
            "telephone_number": "716-366-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 COMMERCIAL ST",
            "city": "GOWANDA",
            "state": "NY",
            "postal_code": "140701408",
            "telephone_number": "716-532-8100",
            "fax_number": "716-241-7365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKS - TLC HOSPITAL SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "716-363-7207"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00347544",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gowanda, NY

Sources for this page

Verify at the official NPI Registry.