Massena Hospital Inc
Organization Active NPI Critical Access Hospital · Massena, NY
NPI 1972604460 · NPPES record last updated Oct 14, 2025
Key facts
- NPI
- 1972604460
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 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
- Organization subpart
- No
Authorized official
- Name
- David Bender
- Title
- Ceo/Ao
- Phone
- (315) 769-4200
Owners & managing parties with NPI records 2
-
Bedros Bakirtzian, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 2
Facilities with the same owner 1
Practitioners 189
-
Emma Brackett, LCSW
-
Luis Ivan Canales, M.D.
-
Jessica L Duhaime, CNM
-
Joshua L Frank, M.D.
-
Jamie Lynn Gibson, FNP
-
Todd R. Howland, MD
-
Linda W Letham, NP
-
Rebecca Monica Love, LCSW-R
-
Matthew Bonner McLain, ACNP-BC
-
Leah Militello, MD
-
Megan Parmelee, PA-C
-
Terry Lee Pummer, DO
-
Amanda Ross, NP
-
Roberto L Vargas, M.D.
-
Nay Meng Saechao, NP
Affiliated clinicians 209
-
Lucille Alston, MD
-
Alveena Altaf, MD
-
David H Antecol, MD
-
Paul Edward Auger, CRNA
-
Bedros Bakirtzian, M.D.
-
Jillian Bartling, D.O.
-
Gabrielle Bentley, PA-C
-
Florence C Bero, M.D.
-
Gwen Lindsey Bonner, M.D.
-
Andrea Anne Bonno, FNP-C
-
Flos C Brown, MD
-
Jeffrey J Buran, MD
-
John Stephen Burnett, M.D.
-
Luis Ivan Canales, M.D.
-
Samanthe Caza, FNP-C
-
Matthew Chang, D.O.
Medicare Care Compare: Hospital
- Listed as
- SLHS Massena, Inc
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in NY
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
- Corporation · Non-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
- Corporation · Non-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
- Corporation · Non-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
- Corporation · Non-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
- Corporation · Non-profit
- Incorporated
- Sep 17, 2019 in NY
- Enrollment address
- 1 Hospital Dr
Massena, NY 13662-1056
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Bedros Bakirtzian |
Corporate Director |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2020 | ||
| Michael J Cook |
Corporate Director |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2020 | ||
| Nichole S Holder |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Officer |
Jan 21, 2021 | ||
| Richard O Davis |
Corporate Director | Oct 15, 2025 | |
| Glauco Maresca |
Corporate Director |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2020 | ||
| Matthew Lebire |
Corporate Director | Oct 15, 2025 | |
| Ashley Peggs |
W-2 Managing Employee | Oct 15, 2025 | |
| W-2 Managing Employee |
Sep 30, 2022 | ||
| W-2 Managing Employee | Sep 30, 2022 | ||
| Amy Stark |
Corporate Director | Oct 15, 2025 | |
| Howard Glastonbury |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Officer |
Jan 21, 2021 | ||
| Donna McGregor |
Corporate Director | Oct 15, 2025 | |
| Corporate Officer |
May 24, 2022 | ||
| Corporate Director |
Oct 15, 2025 | ||
| Thomas R Crilly |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Officer |
Jan 21, 2021 | ||
| Kelly Cicchinelli |
Corporate Officer |
May 24, 2022 | |
| St Lawrence Health System, Inc. |
5% Or Greater Direct Ownership Interest | Jan 1, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
77 W Barney St
Gouverneur, NY 13642
Phone (315) 287-1000
181 Maple St
Ste B
Massena, NY 13662
Phone (315) 769-4656
1 Hospital Dr
Fl 3
Massena, NY 13662
Phone (315) 769-1111
10 State Highway 37B
Massena, NY 13662
Phone (315) 514-1330
5660 Indian River Rd
Virginia Beach, VA 23464
Phone (757) 252-5300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | |||
| General Acute Care Hospital | 282N00000X | |||
| Critical Access Hospital | 282NC0060X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | NY |
Other names
- SLHS Massena, Inc
- Town of Massena dba Massena Memorial Hospital
Other providers in Massena, NY
- Massena Central School District
- Massena Hospital Inc
- Massena Hospital Inc
- Massena Hospital Inc
- Massena Hospital Inc
- Massena Hospital, Inc
- Massena Memorial Hospital
- Massena Memorial Hospital Crna
- Massena Optics, Inc.
- Massena Rescue Squad
All providers in Massena, 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 Oct 14, 2025. 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.