St. Johnsville Rehabilitation and Nursing Center Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2828300N Issued in NY

Legal business name

ST. JOHNSVILLE REHABILITATION AND NURSING CENTER INC

Practice address

7 Timmerman Ave
St Johnsville, NY 13452-1017

Phone

(518) 568-5037

Fax

(518) 568-5477

NPI assigned

Jul 6, 2005

Last updated

May 4, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Michele A Dygert

Title

Director of Finance

Phone

(518) 568-5037

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740287770. Details of each certification follow.

• CCN 335704001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335704001

Legal name

ST JOHNSVILLE REHABILITATION AND NURSING CENTER INC

Organization structure

CorporationProprietary

Incorporated

Jan 1, 2002 in NY

Enrollment address

7 Timmerman Ave
Saint Johnsville, NY 13452-1017

Nursing home name

ST JOHNSVILLE REHABILITATION AND NURSING CENTER

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

CLIA laboratory certificates

All disclosed owners & managing parties 7

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

Practitioners 2

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.

• Elizabeth Cooley, MD

  • Family Medicine Physician
  • Utica, NY
  • NPI 1871748020
  NPD (past)
• David D Liu, MD

  • Internal Medicine Physician
  • Mohawk, NY
  • NPI 1225050404
  NPD (past)

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430697600000",
    "number": "1740287770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 TIMMERMAN AVE",
            "city": "ST JOHNSVILLE",
            "state": "NY",
            "postal_code": "134521017",
            "telephone_number": "518-568-5037",
            "fax_number": "518-568-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 TIMMERMAN AVE",
            "city": "ST JOHNSVILLE",
            "state": "NY",
            "postal_code": "134521017",
            "telephone_number": "518-568-5037",
            "fax_number": "518-568-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNSVILLE REHABILITATION AND NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-06",
        "last_updated": "2015-05-04",
        "status": "A",
        "authorized_official_last_name": "DYGERT",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "518-568-5037",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "2828300N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01131093",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ina F Smith, LCSW-R
• Susan Anne Smith, RN
• Ranbir S Sodhi, M.D.
• St. Johnsville Area Volunteer Ambulance Corp
• St. Johnsville Central School
• St. Mary's Healthcare
• Olivia Stewart, RN
• Bethany Straney
• Therapy Specialists, PLLC
• Andrew Lloyd Wheelock III

• Skilled Nursing Facility in St Johnsville, NY
• Providers in St Johnsville, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2015; 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.
• 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.