NPIMap

Organization Active NPI

Rochester General Hospital

Doing business as Wayne Medical Group

  • Internal Medicine Physician
  • Sodus, NY
National Provider Identifier
1821163718
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ROCHESTER GENERAL HOSPITAL
Doing business as
Wayne Medical Group
Practice address
6692 Middle Rd
Sodus, NY 14551-9602
Phone
(315) 483-9135
NPI assigned
Nov 24, 2006
Last updated
Jun 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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

Authorized official

Name
Paula Tinch
Title
SVP-Finance
Phone
(585) 922-1223

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU Primary
Gastroenterology Physician 207RG0100X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU
Urology Physician 208800000X NU

Addresses

Primary practice location

6692 Middle Rd
Sodus, NY 14551-9602

Mailing address

6692 Middle Rd
Sodus, NY 14551-9602
Phone (315) 483-9135

Other identifiers 1

IdentifierTypeStateIssuer
00303315MedicaidNY

Other names 1

  • Wayne Medical Group Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000644 NY Part B Supplier - Clinic/Group Practice 0244149474 Receives reassigned benefits from 2,800 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20061017000162 NY Part A Provider - Hospital 0244149474 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821163718. Details of each certification follow.

Hospital certification: CCN 330125001

Legal name
ROCHESTER GENERAL HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
1425 Portland Ave
Rochester, NY 14621-3001
Opt Extension Site
Hospital subgroups
General

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

12 Leach Rd
Lyons, NY 14489
Phone (315) 946-6075

220 Alexander St
Ste 708
Rochester, NY 14607
Phone (585) 922-6200

6692 Middle Rd
Sodus Center, NY 14551
Phone (315) 483-3205

2000 Empire Blvd
Webster, NY 14580
Phone (585) 922-0374

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Julia C Tedesco Individual Corporate DirectorBoard Secretary Jul 1, 2019
Marcy Cardona Mulconry Individual Corporate DirectorBoard Member Jul 1, 2019
Marcie Salerno Individual W-2 Managing Employee Jan 1, 2021
Karen M Gallina Individual Corporate DirectorBoard Member Jul 1, 2014
Nichole S Holder Individual W-2 Managing EmployeeDirector Payor Enrollment Jul 1, 2020
Richard O Davis Individual Corporate OfficerCeo Mar 1, 2022
Howard Glastonbury Individual Corporate OfficerVice President CFP Corp. Finance May 1, 2020
W-2 Managing EmployeeVP CFP Corporate Finance May 1, 2020
Amanda Wilson Individual W-2 Managing Employee Jan 1, 2024
Leon T Sawyko Individual Corporate DirectorBoard Member Jul 1, 2014
Joseph Miles Individual W-2 Managing Employee Oct 22, 2001
Thomas P Riley Individual Corporate DirectorBoard Member Jul 1, 2014
Michael Cicero Individual Corporate Director Aug 1, 2021
Linda S Becker Individual Corporate DirectorBoard Member Jun 1, 2009
Jeffrey C. Mapstone Individual Corporate DirectorBoard Member Jul 1, 2014
Walter Larkin Individual Corporate Director Aug 1, 2021
Thomas R Crilly Individual Corporate OfficerExecutive Vice President, Cfo Apr 1, 2015
W-2 Managing EmployeeExecutive Vice President, Cfo Apr 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 229

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 229

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1821163718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6692 MIDDLE RD",
            "city": "SODUS",
            "state": "NY",
            "postal_code": "145519602",
            "telephone_number": "315-483-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6692 MIDDLE RD",
            "city": "SODUS",
            "state": "NY",
            "postal_code": "145519602",
            "telephone_number": "315-483-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCHESTER GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "TINCH",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "SVP-FINANCE",
        "authorized_official_telephone_number": "585-922-1223"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00303315",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wayne Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sodus, NY

Sources for this page

Verify at the official NPI Registry.