NPIMap

Organization Active NPI

Prime Healthcare Services - St. Mary's Passaic LLC

Doing business as St. Mary's Hospital

  • General Acute Care Hospital
  • Passaic, NJ
National Provider Identifier
1770901761
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC LLC
Doing business as
St. Mary's Hospital
Practice address
350 Boulevard
Passaic, NJ 07055-2840
Phone
(973) 365-4300
NPI assigned
Apr 7, 2014
Last updated
Apr 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Authorized official

Name
Troy A Schell, ESQ.
Title
Secretary, General Counsel
Phone
(909) 235-4311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

350 Boulevard
Passaic, NJ 07055-2840

Mailing address

3300 E Guasti Rd
Third Floor
Ontario, CA 91761-8655
Phone (909) 235-4311

Other names 1

  • St. Mary's Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141002001573 NJ Part A Provider - Hospital 6305066911 Practice locations: Passaic, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770901761. Details of each certification follow.

Hospital certification: CCN 310006

Legal name
PRIME HEALTHCARE SERVICES - ST MARY'S PASSAIC, LLC
Doing business as
ST. MARY'S GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 17, 2025
Beds
286
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Dec 27, 2012 in DE
Enrollment address
350 Boulevard
Passaic, NJ 70552840
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Mary's General HospitalCCN 310006 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation 5% Or Greater Direct Ownership Interest Dec 27, 2012 100%
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerManaging Associate General Couns Nov 15, 2017
Kasp Trust Organization, Victorville, CA 5% Or Greater Indirect Ownership Interest Dec 27, 2012 100%
Prime Healthcare Holdings Inc Organization, Ontario, CA Holding company 5% Or Greater Indirect Ownership Interest Dec 27, 2012 100%
Edward J Condit Individual Corporate OfficerChief Executive Officer Dec 27, 2012
Corporate DirectorDirector Dec 27, 2012
W-2 Managing Employee Jul 31, 2014

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Practitioners 115

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 115

Affiliated clinicians 218

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

View all 218

NPI Registry JSON

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

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1770901761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E GUASTI RD",
            "address_2": "THIRD FLOOR",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618655",
            "telephone_number": "909-235-4311",
            "fax_number": "909-235-4419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 BOULEVARD",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552840",
            "telephone_number": "973-365-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "SCHELL",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "SECRETARY, GENERAL COUNSEL",
        "authorized_official_telephone_number": "909-235-4311",
        "authorized_official_credential": "ESQ."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Passaic, NJ

Sources for this page

Verify at the official NPI Registry.