Elizabethtown Community Hospital
Organization Active NPI Critical Access Hospital · Elizabethtown, NY
NPI 1891785184 · NPPES record last updated Feb 17, 2024
Key facts
- NPI
- 1891785184
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Rodney Boula
- Title
- Ceo
- Phone
- (518) 873-6377
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 12
Practitioners 209
-
Julie Anderson, RPA-C
-
Eugene Byrne, MD
-
Rob Luke Demuro, M.D.
-
Steven Deso, MD
-
Roger Ishac, MD
-
Jeffrey Klotz, M.D.
-
Julio A Lemos, M.D.
-
Seema A Lodha, M.D.
-
Laura Mulvey, M.D.
-
Vincent Persaud, MD
-
Carly Sleeper, RPA-C
-
Hanna Boutros Slim, M.D.
-
Cody Evan Whitney, PA-C
-
Dragos Banu, M.D.
Affiliated clinicians 334
-
Aref Agheli, MD
-
Ovais Ahmed, M.D.
-
Shahid Ahmed, MD
-
Jerry Albujar, D.P.M
-
Kristine Blais Alix, FNP
-
Loren M Allen, FNP
-
Alveena Altaf, MD
-
Kristin Ambler, M.D.
-
Elizabeth Anderson, DNP FNP
-
Julie Anderson, RPA-C
-
Sergio Apuzzo, MD, PHD
-
Tracy Ann Arguelles, ANP
-
Holly E Bachilas, MD
-
Ephraim E Back, MD
-
Kyle Barbour, MD
-
Casey J Barcomb, PA-C
-
Elizabeth Bartos, M.D.
-
Iqbal Bashir, MD
-
William Bauer, MD
Medicare Care Compare: Hospital
- Listed as
- Elizabethtown Community Hospital
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
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
- Corporation · Non-profit
- Incorporated
- May 8, 1926 in NY
- Enrollment address
- 75 Park St
Elizabethtown, NY 12932-2300
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| William Tansey |
Corporate Director |
Jan 1, 2023 | |
| Steven Cacchio |
Corporate Director |
Jan 1, 2018 | |
| Charles Lender |
Corporate Director |
Jan 1, 2023 | |
| Robert P Ortmyer |
Corporate Officer |
Jul 12, 2021 | |
| W-2 Managing Employee |
Jul 12, 2021 | ||
| Operational/Managerial Control |
Jul 12, 2021 | ||
| David Shelmidine |
Corporate Director |
Jan 1, 2018 | |
| Megan Murphy |
Corporate Director |
Jan 1, 2017 | |
| Susan Allott |
Corporate Director |
Jan 1, 2018 | |
| Evan George |
Corporate Director |
Jan 1, 2020 | |
| The University of Vermont Health Network Inc. |
5% Or Greater Direct Ownership Interest | Nov 17, 2014 | 100% |
| Operational/Managerial Control | Nov 17, 2014 | 100% | |
| Joseph Bogardus |
Corporate Director |
Jan 1, 2021 | |
| Terri a Morse |
Corporate Director |
Jan 1, 2021 | |
| Elizabeth Elkins |
W-2 Managing Employee |
Jan 1, 2023 | |
| Alan Jones |
Corporate Director |
Apr 1, 2022 | |
| Scott a Comeau |
Corporate Officer |
Jul 25, 2022 | |
| W-2 Managing Employee |
Jul 25, 2022 | ||
| Operational/Managerial Control |
Jul 25, 2022 | ||
| Lynne Reale |
Corporate Director |
Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
3040 Route 50
Saratoga Springs, NY 12866
Phone (518) 580-2170
6097 Nys Route 9N
Westport, NY 12993
Phone (518) 962-2313
10 North St
Vergennes, VT 05491
Phone (802) 877-3466
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00354274 | Medicaid | NY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.cioxhealth.com:8291/Gateway/DocumentSubmission/1_1/NhinService/XDRRequest_Service | Other | Ciox Health |
Other providers in Elizabethtown, NY
- Elizabethtown Center LLC
- Elizabethtown Community Hospital
- Elizabethtown Community Hospital
- Elizabethtown Community Hospital
- Elizabethtown Community Hospital
- Elizabethtown-Lewis Central School
- Essex County Public Health Nursing Service
- Essex County Public Health Nursing Service
- Essex County Public Health Nursing Service
- Essex County Public Health Nursing Service
All providers in Elizabethtown, NY · Critical Access Hospital in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.