NPIMap

Organization Active NPI

Ira Davenport Memorial Hospital

  • Critical Access Hospital
  • Bath, NY
National Provider Identifier
1972835957
Registry record updated Apr 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
290044 Issued in NY
Legal business name
IRA DAVENPORT MEMORIAL HOSPITAL
Practice address
7571 State Route 54
Bath, NY 14810-9504
Phone
(607) 776-8564
Fax
(607) 776-8817
NPI assigned
Feb 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2019

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

Authorized official

Name
Mr. Jonathan I. Lawrence
Title
President & Chief Executive Officer
Phone
(607) 737-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 290044 NY Primary

Addresses

Primary practice location

7571 State Route 54
Bath, NY 14810-9504

Mailing address

7571 State Route 54
Bath, NY 14810-9504
Phone (607) 776-8564

Other names 1

  • Davenport and Taylor Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040303000724 NY Part B Supplier - Clinic/Group Practice 6406743459 Receives reassigned benefits from 56 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bath, NY

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1265068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554076800000",
    "number": "1972835957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148109504",
            "telephone_number": "607-776-8564",
            "fax_number": "607-776-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7571 STATE ROUTE 54",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148109504",
            "telephone_number": "607-776-8564",
            "fax_number": "607-776-8817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRA DAVENPORT MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-02",
        "last_updated": "2019-04-01",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "607-737-4100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NY",
            "license": "290044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Davenport and Taylor",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Davenport and Taylor",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bath, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.