NPIMap

Organization Active NPI

Prime Healthcare Services - St. Mary's Passaic LLC

Doing business as St. Mary's General Hospital

  • Psychiatric Hospital Unit
  • Passaic, NJ
National Provider Identifier
1831722586
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
PRIME HEALTHCARE SERVICES - ST. MARY'S PASSAIC LLC
Doing business as
St. Mary's General Hospital
Practice address
350 Boulevard
Passaic, NJ 07055-2840
Phone
(973) 365-4300
NPI assigned
Feb 20, 2020
Last updated
Jun 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2021

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

Authorized official

Name
Christopher Doan
Title
Managing Associate General Counsel
Phone
(310) 259-4706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

350 Boulevard
Passaic, NJ 07055-2840

Mailing address

350 Boulevard
Passaic, NJ 07055-2840
Phone (973) 365-4300

Other identifiers 1

IdentifierTypeStateIssuer
0737721MedicaidNJ

Other names 1

  • St. Mary's General Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200408004064 NJ Part A Provider - Hospital 6305066911 Practice locations: Passaic, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831722586. Details of each certification follow.

Hospital certification: CCN 31S006

Legal name
PRIME HEALTHCARE SERVICES - ST MARY'S PASSAIC, LLC
Doing business as
ST. MARY'S GENERAL HOSPITAL
Organization structure
LLCProprietary
Incorporated
Dec 27, 2012 in DE
Enrollment address
350 Boulevard
Passaic, NJ 70552840
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

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).

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services -6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 5

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%
Christopher Doan Individual Corporate OfficerManaging Associate General Counsel 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 Corporation 5% Or Greater Indirect Ownership Interest Dec 27, 2012 100%
Edward J Condit Individual Corporate OfficerChief Executive Officer Oct 1, 2012
Corporate DirectorDirector Oct 1, 2012
W-2 Managing EmployeeChief Executive Officer Oct 1, 2012

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1582156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1831722586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 BOULEVARD",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552840",
            "telephone_number": "973-365-4300"
        },
        {
            "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": "2020-02-20",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0737721",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's General Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Mary's General Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Passaic, NJ

Sources for this page

Verify at the official NPI Registry.