NPIMap

Hudson Headwaters Health Network

Organization Active NPI Primary Care Clinic/Center · North Creek, NY

NPI 1811091028 · NPPES record last updated Feb 23, 2024

Key facts

NPI
1811091028
Entity type
Organization (NPI type 2)
Primary specialty
Primary Care Clinic/Center 261QP2300X
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
126 Ski Bowl Rd
North Creek, NY 12853-2607
Phone
(518) 251-2541
Fax
(518) 251-3055
NPI assigned
Sep 8, 2006
Organization subpart
Yes
Parent organization (as reported)
HUDSON HEADWATERS HEALTH NETWORK

Authorized official

Name
Laura Pasco
Title
Executive VP, Cfo
Phone
(518) 761-0300

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

Corporate family (same tax ID) 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

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

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in NY

Federally qualified health center certification: CCN 331853

Legal name
HUDSON HEADWATERS HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1993
Last certification
Jan 1, 1993
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jul 15, 1981 in NY
Enrollment address
126 Ski Bowl Rd
North Creek, NY 12853-2607

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Kristina Hermance
Individual 		Corporate Officer
VP, Logistics		 Jul 23, 2023
Stephen T Shafer
Individual 		Corporate Director
Board Member		 Jul 25, 2024
Linda Spokane
Individual 		Corporate Officer
President & Program Director, Pace		 Oct 23, 2017
Tracy Mills
Individual 		Corporate Officer
Executive VP, Network Strategy		 Jan 3, 2022
Vicki Demarse-Giroux
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Kevin Dougrey
Individual 		Corporate Officer
VP, Medical Staff Operations		 Aug 31, 2020
David Tucker Slingerland
Individual 		Corporate Officer
Ceo		 Jun 1, 2014
Laura S Pasco
Individual 		Corporate Officer
Executive VP, Finance & Cfo		 Sep 19, 2022
W-2 Managing Employee
Executive VP, Finance & Cfo		 Jan 14, 2024
Thomas Dodd
Individual 		Corporate Director
Board Member, Vice-Chairperson		 Nov 18, 2021
Jill Coombes
Individual 		Corporate Officer
VP, Compliance, Cco		 Apr 5, 2020
Deana Ketchum
Individual 		Corporate Director
Board Member, at Large Member		 Feb 24, 2022
Jessica Rubin
Individual 		Corporate Officer
VP, Chief Impact Officer		 Apr 5, 2020
Christine a Rowe-Button
Individual 		Corporate Director
Board Member, Secretary		 Nov 18, 2021
James J Morris
Individual 		Corporate Director
Board Member, Treasurer		 Feb 25, 2016
Robert Nemer
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Justin Miller
Individual 		Corporate Officer
Evp, Chief Information Officer		 Jan 15, 2024
Susan Corney
Individual 		Corporate Officer
Executive VP, Human Resources		 Sep 6, 2017
William M Borgos
Individual 		Corporate Officer
Chief Medical Officer		 Oct 1, 2019
Darren Woods
Individual 		Corporate Director
Board Member		 Nov 18, 2021
Matthew Henderson
Individual 		Corporate Officer
Executive VP, General Counsel		 Dec 29, 2019
Patricia a Auer
Individual 		Corporate Director
Board Member		 Feb 25, 2021
Cathleen Traver
Individual 		Corporate Officer
VP, Planning and Grants		 Sep 18, 2023
Brittany Silvestri
Individual 		Corporate Officer
Evp, Chief Operating Officer		 Aug 8, 2021
Maureen Poole
Individual 		Corporate Officer
VP, Nursing		 Oct 3, 2021
Peter Reale
Individual 		Corporate Director
Board Member		 Feb 25, 2016
Donna Nichols
Individual 		Corporate Director
Board Member, Chairperson		 Jun 28, 2018

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031117000239 NY Part B Supplier - Clinic/Group Practice 7416861208 Receives reassigned benefits from 266 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupper Lake, NY; Warrensburg, NY; Ticonderoga, NY; Schroon Lake, NY; Saranac Lake, NY; Salem, NY; Queensbury, NY; Plattsburgh, NY…
O20090707000327 NY Part a Provider - Federally Qualified Health Center (FQHC) 7416861208 Practice locations: North Creek, NY

National Provider Directory

Tax ID family
Hudson Headwaters HLTH (43 organizations share this tax ID)
Part of
Hudson Headwaters HLTH

Locations

126 Ski Bowl Rd
North Creek, NY 12853
Phone (518) 251-2541

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 104100000X NY
Nutritionist
Group: 193200000X MULTI-SPECIALTY GROUP		 133N00000X NY
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X NY
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X NY
Obstetrics & Gynecology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207V00000X NY
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X NY
Podiatrist
Group: 193200000X MULTI-SPECIALTY GROUP		 213E00000X NY
Federally Qualified Health Center (FQHC) 261QF0400X
Primary Care Clinic/Center 261QP2300X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X NY
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X NY

Addresses

Primary practice location

126 Ski Bowl Rd
North Creek, NY 12853-2607

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Other identifiers

IdentifierTypeStateIssuer
03291027MedicaidNY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 23, 2024.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708646400000",
    "number": "1811091028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 SKI BOWL RD",
            "city": "NORTH CREEK",
            "state": "NY",
            "postal_code": "128532607",
            "telephone_number": "518-251-2541",
            "fax_number": "518-251-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2006-09-08",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE VP, CFO",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03291027",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Creek, NY

All providers in North Creek, NY · Primary Care Clinic/Center in New York

Sources for this page

Verify at the official NPI Registry.