NPIMap

Organization Active NPI

Athol Memorial Hospital Incorporated

Doing business as Athol Primary Care

  • Rural Health Clinic/Center
  • Athol, MA
National Provider Identifier
1952966491
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ATHOL MEMORIAL HOSPITAL INCORPORATED
Doing business as
Athol Primary Care
Practice address
2033 Main St
Athol, MA 01331-3535
Phone
(978) 249-1295
Fax
(978) 249-1550
NPI assigned
May 9, 2019
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
ATHOL MEMORIAL HOSPITAL INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Thomas J Sullivan
Title
Ceo
Phone
(978) 630-6157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

2033 Main St
Athol, MA 01331-3535

Mailing address

242 Green St
Gardner, MA 01440-1336
Phone (978) 632-3420

Other names 1

  • Athol Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190531000142 MA Part A Provider - Rural Health Clinic 7911959846 Practice locations: Athol, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952966491. Details of each certification follow.

Rural health clinic certification: CCN 223980

Legal name
ATHOL MEMORIAL HOSPITAL INCORPORATED
Doing business as
ATHOL PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 15, 2020
Last certification
Apr 15, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1918 in MA
Enrollment address
2033 Main St
Athol, MA 01331-3535
Related CCNs
221303

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).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2160380Athol Primary Care2033 Main St, Athol, MA 01331Certificate of waiverJan 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
North Quabbin Health PL3 organizations share this tax ID, including this one
Part of
North Quabbin Health PL

Other organizations with this tax ID 2

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

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
Craig S Twohey Individual Corporate DirectorBoard Member Feb 1, 2015 4.76%
Joanne a Parks Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Thomas Sullivan Individual Contracted Managing EmployeeAd; Aug 1, 2024
Corporate OfficerCeo Feb 5, 2024
Corporate DirectorCeo Feb 5, 2024
Elizabeth M Nottleson Individual Corporate DirectorBoard Member Dec 1, 2014 4.76%
Albert S Rose Individual Corporate DirectorBoard Member Jan 25, 2018 4.76%
John Bujak Individual Corporate Officer Aug 1, 2024
Corporate Director Aug 1, 2024
W-2 Managing EmployeeAd; Aug 1, 2024
Operational/Managerial ControlCfo Aug 1, 2024
Roy V Lake Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Heywood Healthcare Inc Organization, Gardner, MA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2012 100%
Operational/Managerial Control Dec 1, 2012 100%
Tina M Sbrega Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Cheney M Castine Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Glenn a Hunt Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
John M Skrzypczak Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Robert F Chauvin Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Joel R Shaughnessy Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%
Joyce C Fletcher Individual Corporate DirectorBoard Member Dec 31, 2012 4.76%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1952966491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 GREEN ST",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "014401336",
            "telephone_number": "978-632-3420",
            "fax_number": "978-669-5952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2033 MAIN ST",
            "city": "ATHOL",
            "state": "MA",
            "postal_code": "013313535",
            "telephone_number": "978-249-1295",
            "fax_number": "978-249-1550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHOL MEMORIAL HOSPITAL INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATHOL MEMORIAL HOSPITAL INCORPORATED",
        "enumeration_date": "2019-05-09",
        "last_updated": "2023-06-08",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-630-6157"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athol Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Athol Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Athol, MA

Sources for this page

Verify at the official NPI Registry.