NPIMap

Organization Active NPI

Hudson Headwaters Health Network

  • Primary Care Clinic/Center
  • Salem, NY
National Provider Identifier
1982417119
Registry record updated Apr 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Practice address
1830 County Route 64
Salem, NY 12865-3404
Phone
(518) 824-2571
Fax
(833) 438-0104
NPI assigned
Jan 30, 2025
Last updated
Apr 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
HUDSON HEADWATERS HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2025

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

Authorized official

Name
Laura Pasco
Title
Executive VP, Cfo
Phone
(518) 761-0300

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Medicine Physician 207Q00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

1830 County Route 64
Salem, NY 12865-3404

Mailing address

9 Carey Rd
Queensbury, NY 12804-7880
Phone (518) 761-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031117000239 NY Part B Supplier - Clinic/Group Practice 7416861208 Receives reassigned benefits from 266 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tupper Lake, NY; Warrensburg, NY; Ticonderoga, NY; Schroon Lake, NY; Saranac Lake, NY; Salem, NY; Queensbury, NY; Plattsburgh, NY…
O20250910004156 NY Part A Provider - Federally Qualified Health Center (FQHC) 7416861208 Practice locations: Salem, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982417119. Details of each certification follow.

Federally qualified health center certification: CCN 571915

Legal name
HUDSON HEADWATERS HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 2025
Last certification
Jul 15, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1830 County Route 64
Salem, NY 12865-3404

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Hudson Headwaters Healt43 organizations share this tax ID, including this one
Part of
Hudson Headwaters Healt

Other organizations with this tax ID 42

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

View all 42

Locations

1305 Route 9
Gansevoort, NY 12831
Phone (888) 291-9195

118 Broad St
Glens Falls, NY 12801
Phone (518) 792-2223

38 Larose St
Glens Falls, NY 12801
Phone (518) 824-8181

6356 Nys Route 30
Indian Lake, NY 12842
Phone (518) 648-5707

27 Hyland Dr
Lake Luzerne, NY 12846
Phone (518) 696-2378

203 Old Military Rd
Lake Placid, NY 12946
Phone (518) 523-1327

14 Manor Dr
Queensbury, NY 12804
Phone (518) 798-6400

1830 County Route 64
Salem, NY 12865
Phone (518) 824-2571

2249 State Route 86
Ste 3
Saranac Lake, NY 12983
Phone (518) 891-3845

Ownership & related parties

All disclosed owners & managing parties 26

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

NameRoleSinceShare
Kristina Hermance Individual Corporate OfficerVP, Logistics Jul 23, 2023
Stephen T Shafer Individual Corporate DirectorBoard Member Jul 25, 2024
Linda Spokane Individual Corporate OfficerPresident & Program Director, Pace Oct 23, 2017
Tracy Mills Individual Corporate OfficerEvp, Network Strategy Jan 3, 2022
Vicki Demarse-Giroux Individual Corporate DirectorBoard Member Nov 18, 2021
Kevin Dougrey Individual Corporate OfficerVP, Medical Staff Operations Aug 31, 2020
David Tucker Slingerland Individual Corporate OfficerCeo Jun 1, 2014
Laura S Pasco Individual Corporate OfficerEvp, Finance & Cfo Sep 19, 2022
W-2 Managing EmployeeEvp, Finance & Cfo Jan 14, 2024
Thomas Dodd Individual Corporate DirectorBoard Member, Vice-Chairperson Nov 18, 2021
Jill Coombes Individual Corporate OfficerVP, Compliance, Cco Apr 5, 2020
Deana Ketchum Individual Corporate DirectorBoard Member, at Large Member Feb 24, 2022
Jessica Rubin Individual Corporate OfficerVP, Chief Impact Officer Apr 5, 2020
Christine a Rowe-Button Individual Corporate DirectorBoard Member, Secretary Nov 18, 2021
James J Morris Individual Corporate DirectorBoard Member, Treasurer Feb 25, 2016
Robert Nemer Individual Corporate DirectorBoard Member Nov 18, 2021
Justin Miller Individual Corporate OfficerEvp, Chief Information Officer Jan 15, 2024
Susan Corney Individual Corporate OfficerEvp, Human Resources Sep 6, 2017
William M Borgos Individual Corporate OfficerChief Medical Officer Oct 1, 2019
Darren Woods Individual Corporate DirectorBoard Member Feb 16, 2023
Matthew Henderson Individual Corporate OfficerEvp, General Counsel Dec 29, 2019
Patricia a Auer Individual Corporate DirectorBoard Member Feb 25, 2021
Cathleen Traver Individual Corporate OfficerVP, Planning and Grants Sep 18, 2023
Brittany Silvestri Individual Corporate OfficerEvp, Chief Operating Officer Aug 8, 2021
Maureen Poole Individual Corporate OfficerVP, Nursing Oct 3, 2021
Peter Reale Individual Corporate DirectorBoard Member Feb 25, 2016
Donna Nichols Individual Corporate DirectorBoard Member, Chairperson Jun 28, 2018

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 260

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 260

NPI Registry JSON

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744502400000",
    "number": "1982417119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 CAREY RD",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128047880",
            "telephone_number": "518-761-0300",
            "fax_number": "518-824-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 COUNTY ROUTE 64",
            "city": "SALEM",
            "state": "NY",
            "postal_code": "128653404",
            "telephone_number": "518-824-2571",
            "fax_number": "833-438-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HUDSON HEADWATERS HEALTH NETWORK",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-04-13",
        "certification_date": "2025-04-13",
        "status": "A",
        "authorized_official_last_name": "PASCO",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE VP, CFO",
        "authorized_official_telephone_number": "518-761-0300"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NY

Sources for this page

Verify at the official NPI Registry.