NPIMap

Organization Active NPI

Mercy Health - Tiffin Hospital LLC

  • Rural Health Clinic/Center
  • New Washington, OH
National Provider Identifier
1053965053
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Feb 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

202 W Mansfield St
New Washington, OH 44854-9532

Mailing address

202 W Mansfield St
New Washington, OH 44854-9532

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053965053. Details of each certification follow.

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
LLCNon-profit
Incorporated
May 5, 1970 in OH
Enrollment address
202 W Mansfield St
New Washington, OH 44854-9532
Related CCNs
360089

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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
36D1004211Mercy Health Tiffin Hospital202 W Mansfield St, New Washington, OH 44854Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

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 DirectorBoard Member Jan 1, 2022
Gina Skolmowski Individual Corporate DirectorBoard Member Jan 1, 2021
Wendy Huntley Individual Corporate DirectorBoard 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 DirectorBoard Member Feb 22, 2024
Mark Ridenour Individual Corporate DirectorBoard Member Jan 1, 2021
Wael N Haidar Individual Corporate DirectorBoard Member Jan 1, 2023
Jason Kucsma Individual Corporate DirectorBoard Member Jan 1, 2021
Robert Baxter Individual Corporate DirectorBoard Member Jan 1, 2021
David Zenk Individual Corporate DirectorBoard 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 DirectorBoard Member Jan 1, 2025
John Starcher Individual Operational/Managerial ControlCho Admin Mar 16, 2016
Andrew Morgan Individual Corporate OfficerPresident Oct 4, 2022
Corporate DirectorBoard Member Oct 4, 2022
W-2 Managing EmployeePresident Oct 4, 2022
Marvin L Whitfield Individual Corporate DirectorBoard Member Jan 1, 2025
Randall William King Individual Corporate DirectorBoard Member Jan 1, 2022
James Brazeau Individual Corporate DirectorBoard Member Jan 1, 2026
Bridget Deegan-Krause Individual Corporate DirectorBoard Member Jan 1, 2021
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Apr 7, 2005
Thomas E Bush Individual Corporate DirectorBoard Member Jan 1, 2026
Luis Santiago Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 1

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

Facilities with the same owner 97

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

View all 97

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1564358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771804800000",
    "number": "1053965053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 W MANSFIELD ST",
            "city": "NEW WASHINGTON",
            "state": "OH",
            "postal_code": "448549532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 W MANSFIELD ST",
            "city": "NEW WASHINGTON",
            "state": "OH",
            "postal_code": "448549532",
            "telephone_number": "419-492-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH - TIFFIN HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-29",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP REIMBURSEMENT",
        "authorized_official_telephone_number": "419-996-5119"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Washington, OH

Sources for this page

Verify at the official NPI Registry.