NPIMap

Organization Active NPI

Elizabethtown Community Hospital

  • Critical Access Hospital
  • Elizabethtown, NY
National Provider Identifier
1891785184
Registry record updated Feb 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
ELIZABETHTOWN COMMUNITY HOSPITAL
Practice address
75 Park St
Elizabethtown, NY 12932-2300
Phone
(518) 873-6377
Fax
(518) 873-2315
NPI assigned
Oct 27, 2005
Last updated
Feb 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2024

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

Authorized official

Name
Mr. Rodney Boula
Title
Ceo
Phone
(518) 873-6377

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

75 Park St
Elizabethtown, NY 12932-2300

Mailing address

75 Park St
PO Box 277
Elizabethtown, NY 12932-0277
Phone (518) 873-6377

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service Other Ciox Health

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040521000534 NY Part B Supplier - Clinic/Group Practice 3577554138 Receives reassigned benefits from 226 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Au Sable Forks, NY; Crown Point, NY; Elizabethtown, NY; Ticonderoga, NY; Westport, NY; Willsboro, NY; Wilmington, NY
O20101110000259 NY Part A Provider - Critical Access Hospital 3577554138 Receives reassigned benefits from 160 practitioners
1 other NPI on this enrollment
Practice locations: Wilmington, NY; Willsboro, NY; Westport, NY; Ticonderoga, NY; Elizabethtown, NY; Crown Point, NY; Au Sable Forks, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891785184. Details of each certification follow.

Hospital certification: CCN 331302

Legal name
ELIZABETHTOWN COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 1997
Last certification
May 19, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 8, 1926 in NY
Enrollment address
75 Park St
Elizabethtown, NY 12932-2300
Other Hospital Practice Location

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 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Elizabethtown Community HospitalCCN 331302 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

2679 Main St
Crown Point, NY 12928
Phone (518) 216-4076

101 Adirondack Dr
Ticonderoga, NY 12883
Phone (518) 585-3700

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
William Tansey Individual Corporate DirectorBoard Member Jan 1, 2023
Steven Cacchio Individual Corporate DirectorTreasurer Jan 1, 2018
Charles Lender Individual Corporate DirectorBoard Member Jan 1, 2023
Robert P Ortmyer Individual Corporate OfficerPresident Jul 12, 2021
W-2 Managing EmployeePresident Jul 12, 2021
Operational/Managerial ControlPresident Jul 12, 2021
David Shelmidine Individual Corporate DirectorBoard Member Jan 1, 2018
Megan Murphy Individual Corporate DirectorBoard Member Jan 1, 2017
Susan Allott Individual Corporate DirectorBoard Member Jan 1, 2018
Evan George Individual Corporate DirectorSecretary Jan 1, 2020
The University of Vermont Health Network Inc. Organization, Burlington, VT Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 17, 2014 100%
Operational/Managerial Control Nov 17, 2014 100%
Joseph Bogardus Individual Corporate DirectorBoard Member Jan 1, 2021
Terri a Morse Individual Corporate DirectorBoard Member Jan 1, 2021
Elizabeth Elkins Individual W-2 Managing EmployeeEnrollment Specialist II Jan 1, 2023
Alan Jones Individual Corporate DirectorBoard Member Apr 1, 2022
Scott a Comeau Individual Corporate OfficerCfo Jul 25, 2022
W-2 Managing EmployeeCfo Jul 25, 2022
Operational/Managerial ControlCfo Jul 25, 2022
Lynne Reale Individual Corporate DirectorBoard Member Jan 1, 2023

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 199

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 199

Affiliated clinicians 334

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 334

NPI Registry JSON

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

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708128000000",
    "number": "1891785184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "address_2": "PO BOX 277",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129320277",
            "telephone_number": "518-873-6377",
            "fax_number": "518-873-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129322300",
            "telephone_number": "518-873-6377",
            "fax_number": "518-873-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETHTOWN COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2024-02-17",
        "certification_date": "2024-02-17",
        "status": "A",
        "authorized_official_last_name": "BOULA",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "518-873-6377",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "esmd.cioxhealth.com and OID is '2.16.840.1.113883.3.6635.1.1'",
            "affiliationName": "Ciox Health",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "925 N Point Pkwy",
            "city": "Alpharetta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300055210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elizabethtown, NY

Sources for this page

Verify at the official NPI Registry.