NPIMap

Organization Active NPI

Hospice of St Lawrence Valley Inc

Doing business as Hospice and Palliative Care of St. Lawrence Valley, Inc

  • Community Based Hospice Care Agency
  • Potsdam, NY
National Provider Identifier
1497758080
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
4429501F Issued in NY
Legal business name
HOSPICE OF ST LAWRENCE VALLEY INC
Doing business as
Hospice and Palliative Care of St. Lawrence Valley, Inc
Practice address
6805 US Highway 11
Potsdam, NY 13676-3131
Phone
(315) 265-3105
Fax
(315) 265-0323
NPI assigned
May 27, 2005
Last updated
Dec 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Authorized official

Name
Mr. Ruth Fishbeck
Title
Executive Director
Phone
(315) 265-3105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 4429501F NY Primary

Addresses

Primary practice location

6805 US Highway 11
Potsdam, NY 13676-3131

Mailing address

6805 US Highway 11
Potsdam, NY 13676-3131
Phone (315) 265-3105

Other identifiers 1

IdentifierTypeStateIssuer
00977028MedicaidNY

Other names 1

  • Hospice and Palliative Care of St. Lawrence Valley, Inc Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060201000486 NY Part A Provider - Hospice 0840204574 Practice locations: Potsdam, NY
O20140903001875 NY Part B Supplier - Clinic/Group Practice 0840204574 Receives reassigned benefits from 10 practitioners
Practice locations: Potsdam, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497758080. Details of each certification follow.

Hospice certification: CCN 331514

Legal name
HOSPICE OF ST LAWRENCE VALLEY INC
Doing business as
HOSPICE AND PALLIATIVE CARE OF ST LAWRENCE VALLEY INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 28, 1986
Last certification
Feb 25, 2021
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1986 in NY
Enrollment address
6805 US Route 11
Potsdam, NY 13676-3131

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice and Palliative Care of St Lawrence ValleyCCN 331514 · All quality measures
Ownership
Non-Profit
Certified
Aug 28, 1986
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hospice and Palliative Care of St Lawrence Valley Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Sonya Boyce Individual Corporate Director May 4, 2020
Chad W Green Individual Corporate DirectorBoard Member Dec 31, 2010 11%
David Ferris Individual Corporate Director May 1, 2019
Jordan Backus Individual Corporate Director May 6, 2019
Ruth Fishbeck Individual Corporate OfficerCeo Nov 2, 2015
W-2 Managing EmployeeCeo Oct 11, 2019
Eleanor Menz Individual Corporate Director Dec 2, 2019
Stacey Tarbox Individual W-2 Managing EmployeeFinance Assistant Oct 11, 2019
Frank McLaughlin Individual Corporate Director Jun 25, 2009
Linda Griffin Individual Corporate Director Jun 25, 2009
David Peggs Individual Corporate Director May 6, 2019
David Hornung Individual Corporate Director Jun 25, 2009
Linda Potter Individual Corporate Director May 6, 2019
David Moulton Individual Corporate Director Jun 25, 2009
Cheryl Shumway Individual Corporate Director May 4, 2020
Laura Cordts Individual Corporate Director May 1, 2019
Charles Stemples Individual Corporate Director May 6, 2019

Practitioners & affiliated clinicians

Practitioners 10

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 6

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": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544140800000",
    "number": "1497758080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6805 US HIGHWAY 11",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136763131",
            "telephone_number": "315-265-3105",
            "fax_number": "315-265-0323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6805 US HIGHWAY 11",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136763131",
            "telephone_number": "315-265-3105",
            "fax_number": "315-265-0323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF ST LAWRENCE VALLEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2018-12-07",
        "status": "A",
        "authorized_official_last_name": "FISHBECK",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-265-3105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NY",
            "license": "4429501F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00977028",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice and Palliative Care of St. Lawrence Valley, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hospice and Palliative Care of St. Lawrence Valley, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potsdam, NY

Sources for this page

Verify at the official NPI Registry.