Mercy Hospital of Watertown United States Catholic Conference

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE

Practice address

199 Pratt St
Watertown, NY 13601-4349

Phone

(315) 782-0415

Fax

(315) 786-0417

NPI assigned

Jan 5, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Terri L Bray, R.N.

Title

DPS/Administrator

Phone

(315) 782-0415

Specialties & licenses 4

Addresses

Other identifiers 8

Other names 1

• Genesis Healthcare of New York Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Samaritan Home Health Inc

  • Home Health Agency
  • Watertown, NY
  • NPI 1487057576

  Sold to, 2016-01-01

  CMS change of ownership

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1710965124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 PRATT ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014349",
            "telephone_number": "315-782-0415",
            "fax_number": "315-786-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 PRATT ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014349",
            "telephone_number": "315-782-0415",
            "fax_number": "315-786-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL OF WATERTOWN UNITED STATES CATHOLIC CONFERENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DPS/ADMINISTRATOR",
        "authorized_official_telephone_number": "315-782-0415",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "2472R0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other, Renal Dialysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01226553",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMM",
            "identifier": "113538582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "337254",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI VALUE OPTIONS",
            "identifier": "344246",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "113538582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMM INS",
            "identifier": "113538582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC ROCHESTER",
            "identifier": "P014001500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1ST UNITED AMERICAN",
            "identifier": "C52892A",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Healthcare of New York",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meade Opticians Inc
• Kayode Medugbon, PHARMD
• Melinda Iketau
• Jaquana Mendez, CASAC
• Margaret Ruth Mendoza, PSY.D.
• Mercy of Northern New York
• Rebecca Mae Merwin
• Amy A Messina
• Neil Robert Metevia Jr., MS
• Emerson S Metzler, RPH

• All providers in Watertown, NY
• Home Health Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.