NPIMap

Organization Active NPI

Cameron Memorial Community Hospital Inc

Doing business as Cameron Family Medicine Fremont

  • Rural Health Clinic/Center
  • Fremont, IN
National Provider Identifier
1043880602
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Doing business as
Cameron Family Medicine Fremont
Practice address
401 S Broad St
Fremont, IN 46737-2114
Phone
(260) 667-5685
Fax
(260) 495-3621
NPI assigned
Jun 28, 2021
Last updated
Feb 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Angela M Logan
Title
Ceo
Phone
(260) 667-5735

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

401 S Broad St
Fremont, IN 46737-2114

Mailing address

416 E Maumee St
Angola, IN 46703-2015
Phone (260) 667-5685

Other names 1

  • Cameron Family Medicine Fremont Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040323001008 IN Part B Supplier - Clinic/Group Practice 9234020835 Receives reassigned benefits from 136 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Angola, IN; Fremont, IN; Fort Wayne, IN
O20211112001251 IN Part A Provider - Rural Health Clinic 9234020835 Practice locations: Fremont, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043880602. Details of each certification follow.

Rural health clinic certification: CCN 158571

Legal name
CAMERON MEMORIAL COMMUNITY HOSPITAL INC
Doing business as
CAMERON FAMILY MEDICINE FREMONT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 18, 2023
Last certification
Jul 18, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1972 in IN
Enrollment address
401 S Broad St
Fremont, IN 46737-2114
Related CCNs
151315

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

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
15D2180441Cameron Family Medicine Fremont401 S Broad St, Fremont, IN 46737Provider-performed microscopyMar 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Cameron Memorial Community Hospital Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Todd C Rumsey Individual Corporate DirectorBoard Treasurer Sep 26, 2017
Ann Rice Individual Corporate DirectorBoard Secretary Jun 23, 2020
Jonathan Orlando Cress Individual Corporate DirectorBoard Member Jan 1, 2015
Michael Connell Individual Corporate DirectorBoard Member Jun 23, 2020
Deborah E McHenry Individual Corporate DirectorBoard Chair Aug 25, 2015
Lynn V Faur Individual Corporate DirectorBoard Member Oct 1, 2022
Thomas L Miller Individual Corporate DirectorBoard Member Jan 1, 2015
Angela M Logan Individual Corporate DirectorBoard Member Oct 14, 2021
W-2 Managing EmployeeCeo Oct 14, 2021 100%
Operational/Managerial ControlCeo Oct 14, 2021
Jeffrey R Nickel Individual Corporate DirectorBoard Member Jan 25, 2018
Donna K Elbrecht Individual Corporate DirectorBoard Member Oct 25, 2022
Cameron Memorial Community Hospital Inc Organization, Angola, IN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2023 100%
John McCoy Individual Corporate DirectorBoard Vice Chair Jan 25, 2018

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Cameron Memorial Community Hospital IncAngola, IN, CCN 15Z315 Hospital Operational/Managerial Control Jan 1, 1989
Cameron Jointaccess Ortho & UrgentAngola, IN, CCN 158545 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 25, 2023
Cameron OB/GYNAngola, IN, CCN 158546 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 25, 2023
Cameron Family Medicine - NorthAngola, IN, CCN 158570 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2021

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1043880602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E MAUMEE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467032015",
            "telephone_number": "260-667-5685",
            "fax_number": "260-495-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S BROAD ST",
            "city": "FREMONT",
            "state": "IN",
            "postal_code": "467372114",
            "telephone_number": "260-667-5685",
            "fax_number": "260-495-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMERON MEMORIAL COMMUNITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-28",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-667-5735"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cameron Family Medicine Fremont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, IN

Sources for this page

Verify at the official NPI Registry.