NPIMap

Camden on Gauley Medical Center Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Summersville, WV

NPI 1013590744 · NPPES record last updated May 8, 2024

Key facts

NPI
1013590744
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER INC
Practice address
415 Main St
Summersville, WV 26651-1343
Phone
(304) 872-1663
Fax
(304) 872-8104
NPI assigned
Apr 30, 2021
Organization subpart
No

Authorized official

Name
Margaret Hickey
Title
Ceo
Phone
(304) 226-5725

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 24

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

Corporate family (same tax ID) 20

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

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WV

Federally qualified health center certification: CCN 581019

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY DENTISTRY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 25, 2023
Last certification
Aug 25, 2023
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Nov 1, 1979 in WV
Enrollment address
415 Main St
Summersville, WV 26651-1343

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Roy Moose
Individual 		Corporate Director
Board Member		 Jan 1, 2010
Elizabeth Snyder
Individual 		Corporate Director
Board Member		 Jan 1, 1997
Barbara Butler
Individual 		Corporate Director
Board Member		 Nov 18, 2019
Brandon Moll
Individual 		Corporate Director
Board Member		 Aug 12, 2022
Sharon Hanna
Individual 		Corporate Director
Board Member		 Jan 1, 1981
Margaret Hickey
Individual 		Corporate Officer
Ceo		 Mar 1, 2011
W-2 Managing Employee
Ceo		 Mar 1, 2011
Operational/Managerial Control
Ceo		 Mar 1, 2011
James Gamble
Individual 		Corporate Director
Board Member		 Jan 1, 1989
Melissa Rogers
Individual 		Corporate Officer
Coo		 Mar 4, 2014
W-2 Managing Employee
Coo		 Mar 4, 2014
Operational/Managerial Control
Coo		 Mar 4, 2014
Tiffany Montgomery
Individual 		Corporate Director
Board Member		 Mar 22, 2021
Jane Sherwood
Individual 		Corporate Officer
Board Member		 Aug 1, 2020

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Camden Family Health
Craigsville, WV · CCN 511091		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center Inc
Summersville, WV · CCN 511145		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230921001953 WV Part a Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Summersville, WV
O20231207000140 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 2 practitioners
Practice locations: Summersville, WV

National Provider Directory

Tax ID family
Camden on Gauley Medical Center Inc (21 organizations share this tax ID)

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.71991

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

415 Main St
Summersville, WV 26651-1343

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 872-1663

Other names

  • Camden Family Dentistry Doing business as

Other providers in Summersville, WV

All providers in Summersville, WV · Federally Qualified Health Center (FQHC) in West Virginia

Sources for this page

Verify at the official NPI Registry.