NPIMap

Organization Active NPI

Grant Memorial Hospital Inc

  • Critical Access Hospital
  • Petersburg, WV
National Provider Identifier
1013603919
Registry record updated Dec 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
GRANT MEMORIAL HOSPITAL INC
Practice address
117 Hospital Dr
Petersburg, WV 26847-9566
Phone
(304) 257-1026
Fax
(304) 257-9776
NPI assigned
Apr 13, 2023
Last updated
Dec 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2023

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

Authorized official

Name
John Sylvia
Title
President and Ceo
Phone
(304) 257-1026

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

117 Hospital Dr
Petersburg, WV 26847-9566

Mailing address

PO Box 1019
Petersburg, WV 26847-1019
Phone (304) 257-1026

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20230614001133 WV Part B Supplier - Clinic/Group Practice 4183082712 Receives reassigned benefits from 85 practitioners
1 other NPI on this enrollment
Practice locations: Petersburg, WV
O20231005003059 WV Part A Provider - Critical Access Hospital 4183082712 Receives reassigned benefits from 86 practitioners
Practice locations: Petersburg, WV
O20231010004187 WV Part A Provider - Hospital 4183082712 Practice locations: Petersburg, WV

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1013603919. Details of each certification follow.

Hospital certification: CCN 511316

Legal name
GRANT MEMORIAL HOSPITAL INC
Doing business as
GRANT MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 21, 2009
Last certification
Jul 31, 2024
Beds
45 (25 certified)
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 2022 in WV
Enrollment address
117 Hospital Dr
Petersburg, WV 26847-9566
Main/Primary Hospital Location

Hospital certification: CCN 51Z316

Legal name
GRANT MEMORIAL HOSPITAL INC
Doing business as
GRANT MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 2022 in WV
Enrollment address
117 Hospital Dr
Petersburg, WV 26847-9566
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved, Other

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Grant Memorial HospitalCCN 511316 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Grant Memorial Hospital Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

10 Mulligan Dr
Petersburg, WV 26847
Phone (304) 257-1402

10 Valley St
Petersburg, WV 26847
Phone (304) 257-1015

10 Valley St
Ste 102
Petersburg, WV 26847
Phone (304) 257-1015

35 S Main St
Petersburg, WV 26847
Phone (304) 257-2606

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Teddy Ketterman Individual Corporate DirectorBoard Member Jul 1, 2023
Tammy Kesner Individual Corporate DirectorChairperson Board Member Jul 1, 2023
Suzanne Park Lewis Individual Corporate DirectorBoard Member May 7, 2026
Faron Shanholtz Individual Corporate DirectorBoard Member May 7, 2026
Felicity Ours Individual Corporate OfficerCeo/Cfo Jan 7, 2025
W-2 Managing EmployeeAd; Jan 17, 2025
West Virginia United Health System, Inc Organization, Morgantown, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Scotty Miley Individual Corporate DirectorBoard Member Jul 1, 2023
Autum Rogers Individual W-2 Managing Employee Jul 1, 2023
Tonya Kitzmiller Individual Corporate DirectorBoard Member May 7, 2026
George Ford Individual Corporate DirectorVice Chairperson Board Member Jul 1, 2023
Benjamin Gerber Individual Corporate DirectorBoard Member May 7, 2026
Allen Collins Individual Corporate DirectorBoard Member May 7, 2026
John Sylvia Individual Corporate OfficerCeo Jul 1, 2023 100%
W-2 Managing EmployeeCeo Jul 1, 2023 100%
Janet Frye Individual Corporate DirectorBoard Member Jul 1, 2023
Hope Vanmeter Individual Corporate OfficerController Jul 1, 2023
W-2 Managing EmployeeController Jul 1, 2023
Allan Kile Individual Corporate DirectorBoard Member Jul 1, 2023
Carrie E Willetts Individual Corporate DirectorBoard Member Jul 1, 2023

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 92

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 92

Affiliated clinicians 115

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

View all 115

NPI Registry JSON

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

{
    "created_epoch": "1681344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1013603919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1019",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471019",
            "telephone_number": "304-257-1026",
            "fax_number": "304-257-9776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 HOSPITAL DR",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268479566",
            "telephone_number": "304-257-1026",
            "fax_number": "304-257-9776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-13",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "SYLVIA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "304-257-1026"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Petersburg, WV

Sources for this page

Verify at the official NPI Registry.