NPIMap

Organization Active NPI

Betsy Ross Rehabilitation Center

  • Skilled Nursing Facility
  • Rome, NY
National Provider Identifier
1881767085
Registry record updated Aug 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
3201307N Issued in NY
Legal business name
BETSY ROSS REHABILITATION CENTER
Practice address
1 Elsie St
Rome, NY 13440-2556
Phone
(315) 339-2220
Fax
(315) 709-0017
NPI assigned
Nov 16, 2006
Last updated
Aug 25, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2015

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

Authorized official

Name
Ms. Christine Louise Brodock
Title
Director of Fiscal Services
Phone
(315) 339-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 3201307N NY Primary

Addresses

Primary practice location

1 Elsie St
Rome, NY 13440-2556

Mailing address

1 Elsie St
Rome, NY 13440-2556
Phone (315) 339-2220

Other identifiers 2

IdentifierTypeStateIssuer
3201307NOtherNYOPERATOR CERTIFICATE NUMB
00353131MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170501000392 NY Part A Provider - Skilled Nursing Facility 0840577862 Practice locations: Rome, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881767085. Details of each certification follow.

Skilled nursing facility certification: CCN 335727001

Legal name
BETSY ROSS REHABILITATION CENTER
Organization structure
CorporationProprietary
Incorporated
May 21, 1998 in NY
Enrollment address
1 Elsie St
Rome, NY 13440-2556
Nursing home name
BETSY ROSS REHABILITATION CENTER, INC

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Brian Chamberlin Individual W-2 Managing EmployeeAdministrator Jun 17, 2016
Donald Altman Individual 5% Or Greater Direct Ownership InterestOwner May 21, 1998 45.05%
Corporate DirectorPresident May 21, 1998 45.05%
Christine L Brodock Individual W-2 Managing EmployeeFinance Director Apr 20, 2017
Joanne Chiaraluce Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2011 9.9%
Corporate DirectorTreasurer Jan 1, 2011 9.9%

Practitioners & affiliated clinicians

Practitioners 3

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440460800000",
    "number": "1881767085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ELSIE ST",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134402556",
            "telephone_number": "315-339-2220",
            "fax_number": "315-709-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELSIE ST",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134402556",
            "telephone_number": "315-339-2220",
            "fax_number": "315-709-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETSY ROSS REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2015-08-25",
        "status": "A",
        "authorized_official_last_name": "BRODOCK",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "DIRECTOR OF FISCAL SERVICES",
        "authorized_official_telephone_number": "315-339-2220",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "3201307N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPERATOR CERTIFICATE NUMB",
            "identifier": "3201307N",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00353131",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, NY

Sources for this page

Verify at the official NPI Registry.