NPIMap

Organization Active NPI

Massena Hospital Inc

  • Critical Access Hospital
  • Massena, NY
National Provider Identifier
1972604460
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MASSENA HOSPITAL INC
Practice address
1 Hospital Dr
Massena, NY 13662-1056
Phone
(315) 769-4200
Fax
(315) 769-4353
NPI assigned
Sep 26, 2006
Last updated
Oct 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
David Bender
Title
Ceo/Ao
Phone
(315) 769-4200

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
General Acute Care Hospital 282N00000X
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1 Hospital Dr
Massena, NY 13662-1056

Mailing address

1 Hospital Dr
Massena, NY 13662-1056
Phone (315) 769-4200

Other names 2

  • SLHS Massena, Inc Former legal business name
  • Town of Massena dba Massena Memorial Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20200515000493 NY Part B Supplier - Clinic/Group Practice 1456781491 Receives reassigned benefits from 173 practitioners
Practice locations: Massena, NY
O20200826002240 NY Part A Provider - Rural Health Clinic 1456781491 Practice locations: Massena, NY
O20200826002864 NY Part A Provider - Rural Health Clinic 1456781491 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Massena, NY
O20200826003675 NY Part A Provider - Rural Health Clinic 1456781491 Practice locations: Massena, NY
O20201026002668 NY Part A Provider - Rural Health Clinic 1456781491 Practice locations: Massena, NY
O20230124000826 NY Part A Provider - Critical Access Hospital 1456781491 Receives reassigned benefits from 35 practitioners
Practice locations: Massena, NY

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1972604460. Details of each certification follow.

Rural health clinic certification: CCN 333401

Legal name
MASSENA HOSPITAL INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 17, 2020
Last certification
Sep 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
181 Maple St
Ste a
Massena, NY 13662-1052
Related CCNs
331322

Rural health clinic certification: CCN 333999

Legal name
MASSENA HOSPITAL INC
Doing business as
SLHS MASSENA INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 17, 2020
Last certification
Sep 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
271 Andrews St
Ste 267
Massena, NY 13662
Related CCNs
331322

Rural health clinic certification: CCN 333400

Legal name
MASSENA HOSPITAL INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 17, 2020
Last certification
Sep 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
15 Hospital Dr
Massena, NY 13662-1092
Related CCNs
331322

Rural health clinic certification: CCN 333402

Legal name
MASSENA HOSPITAL INC
Doing business as
LOUISVILLE FAMILY HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 19, 2020
Last certification
Sep 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
10 State Highway 37B
Massena, NY 13662-3142
Related CCNs
331322

Hospital certification: CCN 331322

Legal name
MASSENA HOSPITAL INC
Doing business as
SLHS MASSENA INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 7, 2023
Last certification
Dec 7, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 17, 2019 in NY
Enrollment address
1 Hospital Dr
Massena, NY 13662-1056
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 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
SLHS Massena, IncCCN 331322 · All quality measures
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

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

181 Maple St
Ste C
Massena, NY 13662
Phone (315) 769-1667

269 Andrews St
Massena, NY 13662
Phone (315) 393-2314

5660 Indian River Rd
Virginia Beach, VA 23464
Phone (757) 252-5300

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Bedros Bakirtzian Individual Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2020
Michael J Cook Individual Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2020
Nichole S Holder Individual Corporate OfficerDirector, Payer Enrollment Jan 1, 2023
Corporate OfficerDirector of Payor Enrollment Jan 21, 2021
Richard O Davis Individual Corporate Director Oct 15, 2025
Glauco Maresca Individual Corporate DirectorBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2020
Matthew Lebire Individual Corporate Director Oct 15, 2025
Ashley Peggs Individual W-2 Managing Employee Oct 15, 2025
W-2 Managing EmployeeProvider Enrollment/Project Manager Sep 30, 2022
W-2 Managing Employee Sep 30, 2022
Amy Stark Individual Corporate Director Oct 15, 2025
Howard Glastonbury Individual Corporate OfficerSVP Finance/Corporate Controller Jan 1, 2023
Corporate OfficerVP Ceo Corporate Finance Jan 21, 2021
Donna McGregor Individual Corporate Director Oct 15, 2025
Corporate OfficerPresident May 24, 2022
Corporate DirectorPresident of SLH Oct 15, 2025
Thomas R Crilly Individual Corporate OfficerEvp/Cfo Jan 1, 2023
Corporate OfficerExecutive VP Cfo Jan 21, 2021
Kelly Cicchinelli Individual Corporate OfficerSystem Controller May 24, 2022
St Lawrence Health System, Inc. Organization, Potsdam, NY Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 185

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 185

Affiliated clinicians 209

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

View all 209

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1972604460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200",
            "fax_number": "315-769-4615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR",
            "city": "MASSENA",
            "state": "NY",
            "postal_code": "136621056",
            "telephone_number": "315-769-4200",
            "fax_number": "315-769-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSENA HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "BENDER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO/AO",
        "authorized_official_telephone_number": "315-769-4200"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SLHS Massena, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Town of Massena dba Massena Memorial Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Massena, NY

Sources for this page

Verify at the official NPI Registry.