NPIMap

Organization Active NPI

Mary M. Gooley Hemophilia Center Inc

  • Clinic/Center
  • Rochester, NY
National Provider Identifier
1568428621
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
33D0705405 Issued in NY
Legal business name
MARY M. GOOLEY HEMOPHILIA CENTER INC
Practice address
1415 Portland Ave
Suite 500
Rochester, NY 14621-3038
Phone
(585) 922-5700
Fax
(585) 922-5775
NPI assigned
Apr 25, 2006
Last updated
Mar 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Authorized official

Name
Mr. Tom Wilmarth
Title
President/Ceo
Phone
(585) 922-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 33D0705405 NY Primary

Addresses

Primary practice location

1415 Portland Ave
Suite 500
Rochester, NY 14621-3038

Mailing address

1415 Portland Ave Ste 500
Rochester, NY 14621-3043
Phone (585) 922-5700

Other identifiers 6

IdentifierTypeStateIssuer
5643168OtherNYAETNA
000921985001OtherNYBCWNY/HEALTHNOW
00355284MedicaidNY
103346CJOtherNYPREFERRED CARE
014005944OtherNYBLUE CHOICE
50OtherNYBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110615000136 NY Part B Supplier - Clinic/Group Practice 8325225527 Receives reassigned benefits from 9 practitioners
Practice locations: Rochester, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0705405Mary M Gooley Hemophilia Center1415 Portland Ave - Suite 500, Rochester, NY 14621Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

1415 Portland Ave
Ste 500
Rochester, NY 14621
Phone (585) 922-5700

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1568428621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE STE 500",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213043",
            "telephone_number": "585-922-5700",
            "fax_number": "585-922-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 PORTLAND AVE",
            "address_2": "SUITE 500",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146213038",
            "telephone_number": "585-922-5700",
            "fax_number": "585-922-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY M. GOOLEY HEMOPHILIA CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "WILMARTH",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "585-922-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "33D0705405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5643168",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCWNY/HEALTHNOW",
            "identifier": "000921985001",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00355284",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "103346CJ",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "014005944",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "50",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.