NPIMap

Organization Active NPI

River Hospital, Inc.

  • Rural Health Clinic/Center
  • Alexandria Bay, NY
National Provider Identifier
1831452994
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RIVER HOSPITAL, INC.
Practice address
4 Fuller St
Alexandria Bay, NY 13607-1391
Phone
(315) 482-1207
Fax
(315) 482-3727
NPI assigned
Jun 22, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Carrie Beth Bova
Title
Director, Revenue Cycle Management
Phone
(315) 482-1207

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Adolescent Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0000X
Adult Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0505X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X

Addresses

Primary practice location

4 Fuller St
Alexandria Bay, NY 13607-1391

Mailing address

4 Fuller St
Alexandria Bay, NY 13607-1316
Phone (315) 482-2511

Other identifiers 5

IdentifierTypeStateIssuer
03011387MedicaidNY
02392854MedicaidNY
1367324943OtherNYHPSA
02381OtherNYHPSA ID MUA
33D1050774OtherNYCLIA

Other names 1

  • River Hospital Clinics Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040614001352 NY Part B Supplier - Clinic/Group Practice 2567372899 Receives reassigned benefits from 110 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alex Bay, NY
O20200113000370 NY Part A Provider - Rural Health Clinic 2567372899 Practice locations: Alexandria Bay, NY

Rural health clinic certification: CCN 333997

Legal name
RIVER HOSPITAL INC
Doing business as
RIVER HOSPITAL CLINICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 8, 2019
Last certification
Jun 19, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 3, 2004 in NY
Enrollment address
6B Fuller St
Alexandria Bay, NY 13607-1316
Related CCNs
331309

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).

Other NPIs on the same Medicare enrollment 1

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

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
Norman Snyder Individual General Partnership InterestBoard Member Jan 1, 2020
Jolene Rosenbarker Individual Corporate DirectorHim Director Aug 1, 2021
David Wallace Individual Corporate DirectorClinic Medical Director Mar 20, 2017
Brooke Parmeter Individual W-2 Managing EmployeeBilling Manager Feb 1, 2012
Andrew Impaglia Individual Corporate OfficerChief Financial Officer Apr 22, 2025
Kelley M Tiernan Individual Corporate OfficerChief Executive Officer Jun 18, 2024

Owners & managing parties with NPI records 1

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

Practitioners 109

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

View all 109

NPI Registry JSON

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

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1831452994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 FULLER ST",
            "city": "ALEXANDRIA BAY",
            "state": "NY",
            "postal_code": "136071316",
            "telephone_number": "315-482-2511",
            "fax_number": "315-482-4981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 FULLER ST",
            "city": "ALEXANDRIA BAY",
            "state": "NY",
            "postal_code": "136071391",
            "telephone_number": "315-482-1207",
            "fax_number": "315-482-3727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-22",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "BOVA",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "DIRECTOR, REVENUE CYCLE MANAGEMENT",
        "authorized_official_telephone_number": "315-482-1207"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03011387",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02392854",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPSA",
            "identifier": "1367324943",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPSA ID MUA",
            "identifier": "02381",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "33D1050774",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Hospital Clinics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Alexandria Bay, NY

Sources for this page

Verify at the official NPI Registry.