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Mercy Health - Tiffin Hospital LLC

Organization Active NPI Rural Health Clinic/Center · New Washington, OH

NPI 1053965053 · NPPES record last updated Feb 23, 2026

Key facts

NPI
1053965053
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MERCY HEALTH - TIFFIN HOSPITAL LLC
Practice address
202 W Mansfield St
New Washington, OH 44854-9532
Phone
(419) 492-1300
NPI assigned
Jul 29, 2019
Organization subpart
No

Authorized official

Name
Kimberly M Ralston
Title
VP Reimbursement
Phone
(419) 996-5119

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 3

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

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

Facilities with the same owner 97

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

View all 97

Practitioners 18

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1004211Mercy Health Tiffin Hospital
202 W Mansfield St, New Washington, OH 44854		Certificate of waiverSep 30, 2027

Medicare participation

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

Rural health clinic certification: CCN 363423

Legal name
MERCY HEALTH - TIFFIN HOSPITAL LLC
Doing business as
MERCY HEALTH - TIFFIN HOSPITAL PRIMARY CARE, NEW WASHINGTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 10, 2019
Last certification
Dec 10, 2019
Ownership / control type
2C
Organization structure
LLC · Non-profit
Incorporated
May 5, 1970 in OH
Enrollment address
202 W Mansfield St
New Washington, OH 44854-9532
Related CCNs
360089

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Dale Thornton
Individual 		Corporate Director
Board Member		 Jan 1, 2022
Gina Skolmowski
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Wendy Huntley
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Mercy Health North LLC
Organization · Toledo, OH
LLC, Non-profit 		5% Or Greater Direct Ownership Interest May 5, 1970 100%
Timothy Goligoski
Individual 		Corporate Director
Board Member		 Feb 22, 2024
Mark Ridenour
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Wael N Haidar
Individual 		Corporate Director
Board Member		 Jan 1, 2023
Jason Kucsma
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Robert Baxter
Individual 		Corporate Director
Board Member		 Jan 1, 2021
David Zenk
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Bon Secours Mercy Health Inc
Organization · Cincinnati, OH
Corporation, Non-profit, Chain home office 		5% Or Greater Indirect Ownership Interest Sep 1, 2018 100%
Alexander Garvey
Individual 		Corporate Director
Board Member		 Jan 1, 2025
John Starcher
Individual 		Operational/Managerial Control
Cho Admin		 Mar 16, 2016
Andrew Morgan
Individual 		Corporate Officer
President		 Oct 4, 2022
Corporate Director
Board Member		 Oct 4, 2022
W-2 Managing Employee
President		 Oct 4, 2022
Marvin L Whitfield
Individual 		Corporate Director
Board Member		 Jan 1, 2025
Randall William King
Individual 		Corporate Director
Board Member		 Jan 1, 2022
James Brazeau
Individual 		Corporate Director
Board Member		 Jan 1, 2026
Bridget Deegan-Krause
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Kimberly M Ralston
Individual 		W-2 Managing Employee
VP Reimbursement		 Apr 7, 2005
Thomas E Bush
Individual 		Corporate Director
Board Member		 Jan 1, 2026
Luis Santiago
Individual 		Corporate Director
Board Member		 Jan 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040324001028 OH Part B Supplier - Clinic/Group Practice 2466343769 Receives reassigned benefits from 1 practitioner
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: New Washington, OH; Tiffin, OH
O20190927001747 OH Part a Provider - Rural Health Clinic 2466343769 Practice locations: New Washington, OH

National Provider Directory

Tax ID family
Mercy Health - Tiffin Hospital LLC (4 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

202 W Mansfield St
New Washington, OH 44854-9532

Mailing address

202 W Mansfield St
New Washington, OH 44854-9532

Other providers in New Washington, OH

All providers in New Washington, OH · Rural Health Clinic/Center in Ohio

Sources for this page

Verify at the official NPI Registry.