NPIMap

Organization Active NPI

Nantucket Cottage Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Nantucket, MA
National Provider Identifier
1750448767
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
2044 Issued in MA
Legal business name
NANTUCKET COTTAGE HOSPITAL
Practice address
57 Prospect St
Nantucket, MA 02554-2799
Phone
(508) 825-8100
Fax
(508) 825-8101
NPI assigned
Jan 2, 2007
Last updated
Jul 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Authorized official

Name
Aaron Fishman
Title
VP Finance
Phone
(508) 825-8205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 2044 MA Primary

Addresses

Primary practice location

57 Prospect St
Nantucket, MA 02554-2799

Mailing address

57 Prospect St
Nantucket, MA 02554-2799
Phone (508) 825-8100

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170316000025 MA Part A Provider - Hospital 1759357601 Practice locations: Nantucket, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750448767. Details of each certification follow.

Hospital certification: CCN 22U177

Legal name
NANTUCKET COTTAGE HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Sep 20, 1911 in MA
Enrollment address
57 Prospect St
Nantucket, MA 25542799
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Derek a Andelloux Individual Corporate Director Sep 13, 2023
Jeanine M Borthwick Individual Corporate Director Aug 24, 2022
Melissa D Philbrick Individual Corporate Director Aug 16, 2019
Melanie R. Sabelhaus Individual Corporate Director Jul 29, 2016
Hillary Reynolds Individual Corporate Officer Aug 21, 2020
Timothy R Mullen Individual Corporate Director Aug 24, 2022
Craig H Muhlhauser Individual Corporate Officer Aug 16, 2019
Elizabeth B Wright Individual Corporate Director Aug 24, 2022
Jeffrey M Drazen Individual Corporate Director Aug 16, 2019
Ronald Levy Individual Corporate Director Aug 21, 2020
Charles K Gifford Individual Corporate Director Apr 19, 2013
Elizabeth Tilney Individual Corporate Director Jan 1, 2024
Matthew Hutter Individual Corporate Director Jan 19, 2024
Gerard Joseph Keneally Individual Corporate Director Aug 17, 2018
Douglass E Karp Individual Corporate Director Jun 1, 2024
David O Volpi Individual Corporate Director Aug 16, 2019
Nancy S Pittman Individual Corporate OfficerVP of Policy Admin. and Contracting Aug 21, 2020
W-2 Managing Employee Jan 5, 2016
Vincent T McDermott Individual Corporate Officer Mar 24, 2023
Anne Klibanski Individual Corporate Director May 1, 2019
Elisabeth JM Schadae Percelay Individual Corporate Director Oct 21, 2016
Mass General Brigham Incorporated Organization, Somerville, MA Corporation Operational/Managerial Control Apr 20, 2010
Amy Lee Individual Corporate OfficerPresident Oct 17, 2022
Heather Mahoney O'Sullivan Individual Corporate Director Mar 3, 2023
Jeannette Ives Erickson Individual Corporate Director Oct 17, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Nantucket Cottage Medical GroupNantucket, MA, CCN 223979 Rural health clinic Operational/Managerial Control (100%) Jul 16, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 15

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 15

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1750448767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 PROSPECT ST",
            "city": "NANTUCKET",
            "state": "MA",
            "postal_code": "025542799",
            "telephone_number": "508-825-8100",
            "fax_number": "508-825-8101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 PROSPECT ST",
            "city": "NANTUCKET",
            "state": "MA",
            "postal_code": "025542799",
            "telephone_number": "508-825-8100",
            "fax_number": "508-825-8101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANTUCKET COTTAGE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "FISHMAN",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "508-825-8205"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MA",
            "license": "2044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius  Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nantucket, MA

Sources for this page

Verify at the official NPI Registry.