NPIMap

Organization Active NPI

St. Mary's Healthcare

  • General Acute Care Hospital
  • Amsterdam, NY
National Provider Identifier
1811977796
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2801001H Issued in NY
Legal business name
ST. MARY'S HEALTHCARE
Practice address
427 Guy Park Ave
Amsterdam, NY 12010-1054
Phone
(518) 842-1900
NPI assigned
Jan 18, 2006
Last updated
Jun 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Authorized official

Name
Jeffrey M. Methven
Title
President/Ceo
Phone
(518) 841-7101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
General Acute Care Hospital 282N00000X 2801001H NY Primary

Addresses

Primary practice location

427 Guy Park Ave
Amsterdam, NY 12010-1054

Mailing address

427 Guy Park Ave
Amsterdam, NY 12010-1054
Phone (518) 842-1900

Other identifiers 1

IdentifierTypeStateIssuer
00351639MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071228000104 NY Part A Provider - Hospital 7618960709 Practice locations: Northville, NY; Gloversville, NY; Nelliston, NY; Johnstown, NY; St Johnsville, NY; Amsterdam, NY; Canajoharie, NY; Charlton, NY
O20231116002784 NY Part A Provider - Other 7618960709 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Amsterdam, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811977796. Details of each certification follow.

Hospital certification: CCN 330047

Legal name
ST. MARY'S HEALTHCARE
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 18, 2025
Beds
149
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 10, 1909 in NY
Enrollment address
427 Guy Park Ave
Main Hospital Location
Amsterdam, NY 12010-1054
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Marys HealthcareCCN 330047 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

425 Guy Park Ave
Ste 201
Amsterdam, NY 12010
Phone (518) 842-2020

425 Guy Park Ave
Ste 302
Amsterdam, NY 12010
Phone (518) 841-7432

446 Guy Park Ave
Amsterdam, NY 12010

4879 State Highway 30
Ste 30
Amsterdam, NY 12010

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Robert Longobucco Individual Corporate DirectorBoard Member Jul 1, 2021
Jason Packer Individual Corporate DirectorBoard Member Jul 1, 2021
Emily T Etzkorn Individual Corporate DirectorBoard Member Jul 1, 2007
Mohammad-Reza Ghazi-Moghadam Individual Corporate DirectorBoard Member Jul 1, 2008
Andrew Heck Individual Corporate DirectorBoard Member Jul 1, 2007
David Santos Individual Corporate DirectorBoard Member Jul 1, 2021
Greg Abbattisti Individual Corporate DirectorBoard Member Jul 1, 2016
Michael Pepe Individual Corporate DirectorBoard Member Jul 1, 2011
Keith Waters Individual W-2 Managing Employee Apr 1, 2019
Benjamin Ziskin Individual Corporate DirectorBoard Member Jul 1, 2021
Mary Anne Heenan Individual Corporate DirectorBoard Member Jul 1, 2014
John Daly Individual Corporate DirectorBoard Member Jul 1, 2007
Susan Davis Individual Corporate DirectorBoard Member Jul 1, 2021
Jeffrey Methven Individual Corporate OfficerPresident & Ceo Dec 1, 2022 100%
Corporate DirectorPresident & Ceo Dec 1, 2022 100%
W-2 Managing EmployeePresident & Ceo Dec 1, 2022 100%
Operational/Managerial ControlPresident & Ceo Dec 1, 2022 100%
Thomas Cichy Individual Corporate DirectorBoard Member Jul 1, 2007

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 61

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 61

Affiliated clinicians 460

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

View all 460

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1811977796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 GUY PARK AVE",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101054",
            "telephone_number": "518-842-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 GUY PARK AVE",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120101054",
            "telephone_number": "518-842-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-18",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "METHVEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "518-841-7101"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NY",
            "license": "2801001H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00351639",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amsterdam, NY

Sources for this page

Verify at the official NPI Registry.