NPIMap

Organization Active NPI

Ira Davenport Memorial Hospital Inc

  • Long Term Care Pharmacy
  • Bath, NY
National Provider Identifier
1659312080
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
014851 Issued in NY
Legal business name
IRA DAVENPORT MEMORIAL HOSPITAL INC
Practice address
7571 State Route 54
Bath, NY 14810-9504
Phone
(607) 776-8500
Fax
(607) 776-8817
NPI assigned
Jun 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

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

Authorized official

Name
Mr. Jonathan I. Lawrence
Title
President & Chief Executive Officer
Phone
(607) 776-8500

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Clinic Pharmacy 3336C0002X
Institutional Pharmacy 3336I0012X
Long Term Care Pharmacy 3336L0003X 014851 NY Primary

Addresses

Primary practice location

7571 State Route 54
Bath, NY 14810-9504

Mailing address

7571 State Route 54
Bath, NY 14810-9504
Phone (607) 776-8500

Other identifiers 3

IdentifierTypeStateIssuer
00332816MedicaidNY
01151844MedicaidNY
2067348OtherPK

Other names 1

  • IRA DAVENPORT MEMORIAL HOSPITAL PHARMACY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000724 NY Part B Supplier - Clinic/Group Practice 6406743459 Receives reassigned benefits from 56 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bath, NY

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

7571 State Route 54
Bath, NY 14810
Phone (607) 776-8500

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1659312080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148109504",
            "telephone_number": "607-776-8500",
            "fax_number": "607-776-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148109504",
            "telephone_number": "607-776-8500",
            "fax_number": "607-776-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA DAVENPORT MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "607-776-8500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NY",
            "license": "014851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00332816",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01151844",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2067348",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IRA DAVENPORT MEMORIAL HOSPITAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "IRA DAVENPORT MEMORIAL HOSPITAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bath, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.