NPIMap

Organization Active NPI

Prime Healthcare Foundation - Coshocton, LLC

  • General Acute Care Hospital
  • Coshocton, OH
National Provider Identifier
1013468172
Registry record updated Nov 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
1129 Issued in OH
Legal business name
PRIME HEALTHCARE FOUNDATION - COSHOCTON, LLC
Practice address
1460 Orange St
Coshocton, OH 43812-2229
Phone
(740) 622-6411
Fax
(740) 622-1238
NPI assigned
Oct 24, 2016
Last updated
Nov 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2019

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

Authorized official

Name
Christopher Doan
Title
Managing Associate General Counsel
Phone
(310) 259-4706

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
General Acute Care Hospital 282N00000X 1129 OH Primary

Addresses

Primary practice location

1460 Orange St
Coshocton, OH 43812-2229

Mailing address

PO Box 1450
Coshocton, OH 43812-6450
Phone (740) 622-6411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170110000687 OH Part B Supplier - Clinic/Group Practice 8820379662 Receives reassigned benefits from 51 practitioners
Practice locations: Coshocton, OH; Newcomerstown, OH
O20170119000357 OH Part A Provider - Hospital 8820379662 Practice locations: Coshocton, OH; Newcomerstown, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013468172. Details of each certification follow.

Hospital certification: CCN 360109

Legal name
PRIME HEALTHCARE FOUNDATION - COSHOCTON, LLC
Doing business as
COSHOCTON REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Dec 31, 2008
Beds
165 (90 certified)
Ownership / control type
Private (not for profit)
Most recent change of ownership
Oct 31, 2016 (2 total)
Organization structure
LLCNon-profit
Incorporated
Jul 15, 2016 in DE
Enrollment address
1460 Orange St
Coshocton, OH 43812-2229
Other Hospital Practice Location
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Coshocton Regional Medical CenterCCN 360109 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0667882Coshocton Regional Medical Center1460 Orange Street, Coshocton, OH 43812AccreditationNov 30, 2027
36D2141948Coshocton Regional Medical Center1460 Orange Street, Coshocton, OH 43812AccreditationJul 25, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

311 S 15th St
Ste 202
Coshocton, OH 43812
Phone (740) 245-3328

6307 E State Rd
Newcomerstown, OH 43832
Phone (740) 498-5515

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 31, 2016 100%
Stephanie Conn Individual Corporate DirectorBoard Member Oct 31, 2016
W-2 Managing EmployeeBoard Member Oct 31, 2016
Steven Aleman Individual Corporate OfficerCorporate Chief Financial Officer Jun 1, 2020
Kavitha R Bhatia Individual Corporate DirectorChair Person Oct 31, 2016
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 1, 2013
Prime Healthcare Foundation Inc Organization, Ontario, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 31, 2016 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 95

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

View all 95

Practitioners & affiliated clinicians

Practitioners 53

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 53

Affiliated clinicians 85

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

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573430400000",
    "number": "1013468172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438126450",
            "telephone_number": "740-622-6411",
            "fax_number": "740-622-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 ORANGE ST",
            "city": "COSHOCTON",
            "state": "OH",
            "postal_code": "438122229",
            "telephone_number": "740-622-6411",
            "fax_number": "740-622-1238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE FOUNDATION - COSHOCTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2019-11-11",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OH",
            "license": "1129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coshocton, OH

Sources for this page

Verify at the official NPI Registry.