1. Home
  2. Directory
  3. New York
  4. Rochester
  5. Clinic Center
  6. NPI Profile

MARY M. GOOLEY HEMOPHILIA CENTER INC
NPI 1568428621
Clinic/Center in Rochester, NY

Active since April 25, 2006CLIA 33D0705405 · Waiver
1415 PORTLAND AVE, SUITE 500, ROCHESTER, NY 14621(585) 922-5700(585) 922-5775 Get Directions Write a Review

NPPES record last updated: March 2, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Mary M. Gooley Hemophilia Center Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY M. GOOLEY HEMOPHILIA CENTER INC (NPI 1568428621) is a healthcare organization registered as a clinic/center in Rochester, New York and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Tom Wilmarth, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1568428621
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameMARY M. GOOLEY HEMOPHILIA CENTER INC
Location Address1415 PORTLAND AVE, SUITE 500Rochester, NY 14621-3038
Mailing Address1415 Portland Ave Ste 500Rochester, NY 14621-3043 · (585) 922-5700 · Fax (585) 922-5775
Phone(585) 922-5700
Fax(585) 922-5775
Organization SubpartNo
Authorized OfficialTom WilmarthPresident/ceo · (585) 922-5700
Enumeration DateApril 25, 2006
Last NPPES UpdateMarch 2, 2021
NPPES CertifiedMarch 2, 2021
✔ NPI 1568428621 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in NY · 33D0705405
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
1415 PORTLAND AVE, Rochester, NY 14621
Open in Google Maps ↗

Other Identifiers 6

Other014005944NY · Blue Choice
Other103346CJNY · Preferred Care
Other50NY · Blue Cross
Other5643168NY · Aetna
Medicaid00355284NY
Other000921985001NY · Bcwny/healthnow

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary M. Gooley Hemophilia Center Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20110615000136Non-DME Part B · Clinic/Group PracticeDue dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

9

Medicare enrollment records show 9 clinicians reassign Medicare billing to Mary M. Gooley Hemophilia Center Inc, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 9 within 10 miles. They are listed nearest first.

Clinicians, nearest first (9)

Tara Veith, FNP
Nurse Practitioner
NPI 1154015162
1415 PORTLAND AVE STE 500
Rochester, NY 14621
(585) 922-5700
✔ PECOS✔ Accepts MedicareSame address
Farhan Imran, MD
Hematology/Oncology
NPI 1518133875
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4020
✔ PECOS✔ Accepts Medicare0.1 mi
Saad Jamshed, MD
Hematology/Oncology
NPI 1659522662
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4020
✔ PECOS✔ Accepts Medicare0.1 mi
Peter Kouides, M.D.
Hematology/Oncology
NPI 1780638775
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4020
✔ PECOS✔ Accepts Medicare0.1 mi
Mehul Patel, MD
Hematology/Oncology
NPI 1528277993
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4020
✔ PECOS✔ Accepts Medicare0.1 mi
Pradyumna Phatak, M.D.
Hematology/Oncology
NPI 1467407213
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4247
✔ PECOS✔ Accepts Medicare0.1 mi
Robin Reid, M.D.
Hematology/Oncology
NPI 1356583355
1425 PORTLAND AVE
Rochester, NY 14621
(585) 922-4000
✔ PECOS✔ Accepts Medicare0.1 mi
Ronald Sham, M.D.
Hematology/Oncology
NPI 1235178500
1425 PORTLAND AVE BOX 242
Rochester, NY 14621
(585) 922-4020
✔ PECOS✔ Accepts Medicare0.1 mi
Gregory Connolly, M.D.
Hematology
NPI 1760590756
601 ELMWOOD AVE BOX MED
Rochester, NY 14642
(585) 275-5823
✔ PECOS✔ Accepts Medicare5.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0705405

Mary M Gooley Hemophilia Center · Rochester, NY
Active · expires Mar 26, 2027
CLIA Number33D0705405
Laboratory TypeCommunity Clinic
Certificate Effective DateSeptember 1, 1994
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Robin M. Reid
Laboratory Phone(585) 922-5700
Laboratory LocationMary M Gooley Hemophilia Center1415 Portland Ave - Suite 500, Rochester, NY 14621
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary M. Gooley Hemophilia Center Inc's NPI number?

The NPI number for Mary M. Gooley Hemophilia Center Inc is 1568428621. It was assigned to this organization in the NPPES registry on April 25, 2006.

Where is Mary M. Gooley Hemophilia Center Inc located?

Mary M. Gooley Hemophilia Center Inc is located at 1415 Portland Ave Suite 500, Rochester, NY 14621. The listed phone number is (585) 922-5700.

What is Mary M. Gooley Hemophilia Center Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Mary M. Gooley Hemophilia Center Inc enrolled in Medicare?

Yes. Mary M. Gooley Hemophilia Center Inc is registered in the Medicare PECOS enrollment system.

When is Mary M. Gooley Hemophilia Center Inc's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (New York, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Mary M. Gooley Hemophilia Center Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 9 clinicians in 3 Medicare specialties reassign their Medicare billing to Mary M. Gooley Hemophilia Center Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Hematology/Oncology (7), Hematology (1) and Nurse Practitioner (1). Of these, 1 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mary M. Gooley Hemophilia Center Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0705405) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mary M. Gooley Hemophilia Center Inc was last updated on March 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.