NPIMap

Organization Active NPI

Gaylord Hospital, Inc.

Doing business as Gaylord Hospital

  • Long Term Care Hospital
  • Wallingford, CT
National Provider Identifier
1730137753
Registry record updated Jul 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
Legal business name
GAYLORD HOSPITAL, INC.
Doing business as
Gaylord Hospital
Practice address
50 Gaylord Farm Rd
Wallingford, CT 06492-2899
Phone
(203) 284-2800
Fax
(203) 294-3294
NPI assigned
May 4, 2006
Last updated
Jul 29, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2026

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

Authorized official

Name
Michael Eldon Ivy, MDNPI 1780693630
Title
Cmo
Phone
(203) 284-2802

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU
Long Term Care Hospital 282E00000X NU Primary

Addresses

Primary practice location

50 Gaylord Farm Rd
Wallingford, CT 06492-2899

Mailing address

PO Box 400
Wallingford, CT 06492-7048
Phone (203) 284-2800

Other identifiers 2

IdentifierTypeStateIssuer
004025284MedicaidCT
000070029MedicaidCT

Other names 1

  • Gaylord Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admissions@direct.gaylord.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040128000878 CT Part B Supplier - Clinic/Group Practice 1153224191 Receives reassigned benefits from 89 practitioners
Practice locations: Fairfield, CT; Wallingford, CT; North Haven, CT; Madison, CT; Guilford, CT; Cromwell, CT; Cheshire, CT
O20040913000154 CT Part A Provider - Hospital 1153224191 Practice locations: Cheshire, CT; Cromwell, CT; Madison, CT; North Haven, CT; Wallingford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730137753. Details of each certification follow.

Hospital certification: CCN 072003

Legal name
GAYLORD HOSPITAL, INC.
Doing business as
GAYLORD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jul 1, 1966
Last certification
Jan 14, 2016
Beds
137
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1902 in CT
Enrollment address
50 Gaylord Farm Rd
Wallingford, CT 64922828
Main/Primary Hospital Location
Hospital subgroups
Long-term

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Gaylord Hospital IncCCN 072003 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1966
Medicare certification status
ActiveFrom the Provider of Services file
Beds
137

National Provider Directory

National Provider Directory
Tax ID family
Gaylord Hospital 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.

Locations

415 Highland Ave
Cheshire, CT 06410
Phone (203) 272-5494

50 Berlin Rd
Ste 1
Cromwell, CT 06416
Phone (203) 284-3020

75 Kings Highway Cutoff
Ste 4A
Fairfield, CT 06824

669 Boston Post Rd
Ste 7
Guilford, CT 06437
Phone (203) 949-3800

28 Durham Rd
Ste 1
Madison, CT 06443

101 Merritt Blvd
Trumbull, CT 06611
Phone (203) 386-8494

180 Hawley Ln
Trumbull, CT 06611
Phone (203) 284-2818

85 Barnes Rd
Wallingford, CT 06492
Phone (203) 697-1067

836 Farmington Ave
Ste 119
West Hartford, CT 06119
Phone (203) 284-2818

687 Campbell Ave
Ste 2B
West Haven, CT 06516
Phone (203) 284-2818

360 Amity Rd
Woodbridge, CT 06525
Phone (203) 284-2818

Interoperability endpoints

  • Direct secure messaging: admissions@direct.gaylord.org

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Peter Deckers Individual Corporate OfficerAssistant Treasurer Jan 1, 2014
Robert Lyons Individual Corporate OfficerAssistant Secretary Jan 1, 2014
Michael E Ivy Individual Corporate OfficerVP Chief Medical Officer Mar 4, 2024
W-2 Managing EmployeeVP Chief Medical Officer Mar 4, 2024
Michael Hoben Individual Corporate OfficerTreasurer Jan 1, 2015
Stephen T Holland Individual Corporate OfficerVP Chief Medical Officer Aug 6, 2012
W-2 Managing EmployeeVP Chief Medical Officer Aug 6, 2012
Christopher Hayes Individual Corporate OfficerCfo Nov 8, 2021
Sonja Labarbera Individual Corporate OfficerPresident & Ceo Jan 1, 2019 100%
Diana Wakerley Individual Corporate OfficerSecretary Jan 1, 2014

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 209

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 209

Affiliated clinicians 168

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

View all 168

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1730137753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 400",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064927048",
            "telephone_number": "203-284-2800",
            "fax_number": "203-294-3294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GAYLORD FARM RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922899",
            "telephone_number": "203-284-2800",
            "fax_number": "203-294-3294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAYLORD HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "IVY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ELDON",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "203-284-2802",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004025284",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000070029",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admissions@direct.gaylord.org",
            "affiliation": "N",
            "address_1": "50 Gaylord Farm Rd",
            "city": "Wallingford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "064922899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Gaylord Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gaylord Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.