NPIMap

Organization Active NPI

Baystate Wing Hospital Corporation

  • General Acute Care Hospital
  • Palmer, MA
National Provider Identifier
1962410233
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2181 Issued in MA
Legal business name
BAYSTATE WING HOSPITAL CORPORATION
Practice address
40 Wright St
Palmer, MA 01069-1138
Phone
(413) 283-7651
Fax
(413) 284-5117
NPI assigned
Aug 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Raymond McCarthy
Title
Sr. VP, Cfo & Treasurer, BH
Phone
(413) 794-3290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 2181 MA Primary

Addresses

Primary practice location

40 Wright St
Palmer, MA 01069-1138

Mailing address

40 Wright St
Palmer, MA 01069-1138
Phone (413) 283-7651

Other identifiers 11

IdentifierTypeStateIssuer
1001191MedicaidMA
903286OtherTUFTS - OUTPATIENT
2222003085OtherMABCBS BEHAVIORAL HLTH
1202057MedicaidMA
2222003010OtherMABCBS HOSPITAL OUTPT.
2222003013OtherMABCBS MEDICAL CENTERS (OV)
797489OtherNETWORK HEALTH
2222003001OtherMABCBS HOSPITAL INPT.
2222003030OtherMABCBS OBSERVATION/SDC
903078OtherHARVARD PILGRIM/HOSPITAL
903285OtherTUFTS - HOSPITAL I/P

Other names 1

  • BAYSTATE WING HOSPITAL & MEDICAL CENTERS Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511000400 MA Part B Supplier - Clinic/Group Practice 9335048321 Receives reassigned benefits from 104 practitioners
Practice locations: Ludlow, MA; Monson, MA; Palmer, MA; Belchertown, MA
O20100701000562 MA Part A Provider - Hospital 9335048321 Practice locations: Palmer, MA; Belchertown, MA; Ware, MA

Hospital certification: CCN 220030

Legal name
BAYSTATE WING HOSPITAL CORPORATION
Doing business as
BAYSTATE WING HOSPITAL & MEDICAL CENTERS
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 31, 1993
Beds
41
Ownership / control type
Other
Most recent change of ownership
Oct 1, 1999 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
40 Wright St
Palmer, MA 10691138
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Baystate Wing HospitalCCN 220030
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 3

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

Locations

759 Chestnut St
Springfield, MA 01107
Phone (413) 794-6297

80 Wason Ave
Springfield, MA 01107
Phone (413) 730-9200

280 Chestnut St
Fl 4
Springfield, MA 01199

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Mark a O'Connell Individual Corporate Director Oct 1, 2023
Nicolas Jabbour Individual Corporate Director Jan 1, 2024
Julie Quink Individual Corporate Director Jan 1, 2024
Ruth H Constantine Individual Corporate Director Oct 1, 2023
Sara a Rourke Individual Corporate Director Oct 1, 2023
Robert Bacon Individual Corporate Director Oct 1, 2023
Ronald Bryant Individual Corporate DirectorPresident Oct 10, 2022
Kelly O Galster Individual Corporate Director Jan 1, 2023
Paul Gosselin Individual Corporate DirectorSenior Director, Finance Jan 27, 2026
Peter Banko Individual Corporate OfficerPresident & Ceo Baystate Health Jun 3, 2024
Corporate DirectorPresident & Ceo Baystate Health Jun 3, 2024
Linda Thompson Individual Corporate Director Oct 1, 2023
Claudia R Coplein Individual Corporate Director Oct 1, 2023
Denise R. Jordan Individual Corporate Director Oct 1, 2023
Baystate Health, Inc Organization, Springfield, MO Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2014 100%
Madeline Landrau Individual Corporate Director Jan 1, 2024
Akinyele K Lovelace Individual Corporate Director Oct 1, 2023
Paul C. Picknelly Individual Corporate Director Oct 1, 2023
Harriet a Deverry Individual Corporate OfficerChair Oct 1, 2023
Corporate Director Oct 1, 2023
Colleen W Holmes Individual Corporate OfficerVice Chair Oct 1, 2023
Corporate Director Oct 1, 2023
Richard D Bossie Individual Corporate Director Oct 1, 2023
Antonio E Dos-Santos Individual Corporate Director Oct 1, 2023
Baystate Administrative Services, Inc. Organization, Springfield, MA Non-profit Operational/Managerial Control Sep 1, 2014
Maria P Goncalves Individual Corporate Director Oct 1, 2023
Irene Rodriguez-Martin Individual Corporate Director Oct 1, 2023
Baystate Wing Hospital Corporation Organization, Palmer, MA Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 1984 100%
Operational/Managerial Control Apr 1, 1984 100%
William R Webber Individual Corporate Director Oct 1, 2023
Laurie Martin Individual Contracted Managing EmployeeCfo & Treasurer Jun 19, 2026
Corporate OfficerTreasurer Jun 19, 2026

Owners & managing parties with NPI records 4

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 124

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 124

Affiliated clinicians 656

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

View all 656

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1962410233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 WRIGHT ST",
            "city": "PALMER",
            "state": "MA",
            "postal_code": "010691138",
            "telephone_number": "413-283-7651",
            "fax_number": "413-284-5117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 WRIGHT ST",
            "city": "PALMER",
            "state": "MA",
            "postal_code": "010691138",
            "telephone_number": "413-283-7651",
            "fax_number": "413-284-5117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSTATE WING HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "SR. VP, CFO & TREASURER, BH",
        "authorized_official_telephone_number": "413-794-3290"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MA",
            "license": "2181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001191",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS - OUTPATIENT",
            "identifier": "903286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS BEHAVIORAL HLTH",
            "identifier": "2222003085",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1202057",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPITAL OUTPT.",
            "identifier": "2222003010",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MEDICAL CENTERS (OV)",
            "identifier": "2222003013",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "797489",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPITAL INPT.",
            "identifier": "2222003001",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OBSERVATION/SDC",
            "identifier": "2222003030",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM/HOSPITAL",
            "identifier": "903078",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS - HOSPITAL I/P",
            "identifier": "903285",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "BAYSTATE WING HOSPITAL & MEDICAL CENTERS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAYSTATE WING HOSPITAL & MEDICAL CENTERS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmer, MA

Sources for this page

Verify at the official NPI Registry.