NPIMap

Organization Active NPI

Claxton-Hepburn Medical Center

Doing business as Practice Resources LLC

  • Psychiatric Hospital
  • Ogdensburg, NY
National Provider Identifier
1891753034
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
CLAXTON-HEPBURN MEDICAL CENTER
Doing business as
Practice Resources LLC
Practice address
214 King St Ste B
Ogdensburg, NY 13669-1142
Phone
(315) 393-3600
Fax
(315) 393-7250
NPI assigned
May 3, 2006
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Rob Bloom
Title
Cfo
Phone
(315) 405-1535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

214 King St Ste B
Ogdensburg, NY 13669-1142

Mailing address

214 King St Ste B
Ogdensburg, NY 13669-1142
Phone (315) 393-3600

Other identifiers 1

IdentifierTypeStateIssuer
02997831MedicaidNY

Other names 1

  • Practice Resources LLC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000552 NY Part B Supplier - Clinic/Group Practice 8426966508 Receives reassigned benefits from 157 practitioners
Practice locations: Waddington, NY; Ogdensburg, NY; Lisbon, NY; Heuvelton, NY; Hammond, NY; Canton, NY; Madrid, NY
O20241211000236 NY Part A Provider - Hospital 8426966508 Practice locations: Ogdensburg, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891753034. Details of each certification follow.

Hospital certification: CCN 334068

Legal name
CLAXTON-HEPBURN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Mar 27, 2025
Last certification
Mar 27, 2025
Beds
40
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
214 King St
Ste B
Ogdensburg, NY 13669
Main/Primary Hospital Location
Hospital subgroups
Psychiatric

Care Compare: Hospital

Medicare Care Compare
Listed as
Claxton-Hepburn Medical CenterCCN 334068 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

88 E Main St
Canton, NY 13617

1001 West St
Carthage, NY 13619
Phone (315) 493-1000

124 Ford Ave
Ogdensburg, NY 13669
Phone (315) 394-9718

214 King St
Ste B
Ogdensburg, NY 13669
Phone (315) 713-5210

39 Main St
Ogdensburg, NY 13669

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Philip a Cosmo Individual Corporate DirectorBoard Member Jan 1, 1983
Michael R Oakley Individual Corporate DirectorBoard of Directors Apr 1, 2021
M Sandra Lyons Individual Corporate DirectorBoard Member Jan 1, 2003
Andrew R Manzer Individual Corporate OfficerInterim Ceo Mar 2, 2026
W-2 Managing EmployeeAd; Mar 2, 2026
Michael Seidman Individual Corporate DirectorBoard Member Jan 1, 2003
James Thew Individual Corporate DirectorBoard Member Jan 1, 2003
Kome Oseghale Individual Corporate Director Apr 1, 2019
Chet a Truskowski Individual Corporate DirectorBoard Member/Vice Chairperson Jan 1, 1983
Maureen L Missert Individual Corporate DirectorBoard Member Jan 1, 2003
Jerian O'Dell Individual Corporate OfficerCoo Apr 2, 2023
Dallas Sutton Individual Corporate Director Apr 1, 2019
James Crowley Individual Corporate Director Apr 1, 2019
Diane Dailey Individual Corporate DirectorBoard of Directors Jan 1, 2021
Bradley D Frey Individual Corporate Director Oct 1, 2018
David Hornung Individual Corporate DirectorBoard of Directors Nov 1, 2016
John Pinkerton Individual Corporate Director Apr 1, 2021
Ted Lawrence Individual Corporate DirectorBoard Member Jan 1, 1983
Mark Mashaw Individual Corporate DirectorBoard Member Jan 1, 2003
Christopher Brandy Individual Corporate DirectorBoard Member Jan 1, 2003
Thomas T Patterson Individual Corporate DirectorBoard Member Jan 1, 2003
Dawn Bronson Merz Individual Corporate DirectorBoard of Directors Jun 1, 2016
Scott a Wilson Individual Corporate Director Apr 1, 2021

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Northern Lights Home Health CareCanton, NY, CCN 337442 Home health agency 5% Or Greater Direct Ownership Interest (33.33%) Aug 27, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 190

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 190

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1891753034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 KING ST STE B",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136691142",
            "telephone_number": "315-393-3600",
            "fax_number": "315-393-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 KING ST STE B",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136691142",
            "telephone_number": "315-393-3600",
            "fax_number": "315-393-7250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAXTON-HEPBURN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2025-09-02",
        "certification_date": "2025-08-21",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "315-405-1535"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02997831",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Practice Resources LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogdensburg, NY

Sources for this page

Verify at the official NPI Registry.