NPIMap

Organization Active NPI

Community Mercy Health Partners

Doing business as Mercy Health - Urbana Hospital Family Medicine and Pediatrics

  • Rural Health Clinic/Center
  • Urbana, OH
National Provider Identifier
1063066066
Registry record updated Dec 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY MERCY HEALTH PARTNERS
Doing business as
Mercy Health - Urbana Hospital Family Medicine and Pediatrics
Practice address
204 Patrick Ave
Urbana, OH 43078-2302
Phone
(937) 484-6157
NPI assigned
Jul 29, 2019
Last updated
Dec 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2020

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

Authorized official

Name
Kimberly M Ralston
Title
System Director
Phone
(419) 996-5119

Specialties & licenses 1

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

Addresses

Primary practice location

204 Patrick Ave
Urbana, OH 43078-2302

Mailing address

PO Box 639761
Cincinnati, OH 45263-9761
Phone (513) 952-5002

Other names 1

  • MERCY HEALTH - URBANA HOSPITAL FAMILY MEDICINE AND PEDIATRICS Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190927001958 OH Part A Provider - Rural Health Clinic 6002884582 Practice locations: Urbana, OH
O20191023002827 OH Part B Supplier - Clinic/Group Practice 6002884582 Receives reassigned benefits from 16 practitioners
Practice locations: Urbana, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063066066. Details of each certification follow.

Rural health clinic certification: CCN 363419

Legal name
COMMUNITY MERCY HEALTH PARTNERS
Doing business as
MERCY HEALTH - URBANA HOSPITAL PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2020
Last certification
Jan 1, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 14, 1969 in OH
Enrollment address
900 Scioto St
Ste 4
Urbana, OH 43078-2251
Related CCNs
361312

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

Other NPIs with the same Medicare PAC ID 5

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

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
36D0700167Mercy Health - Urbana Hospital900 Scioto St Suite 4, Urbana, OH 43078Certificate of waiverOct 12, 2026
36D2041980Mercy Health Urbana Family Medicine204 Patrick Avenue, Urbana, OH 43078Certificate of waiverJun 3, 2028

National Provider Directory

National Provider Directory

Member organizations 4

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

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Jayna Nicole Brown Individual Corporate DirectorBoard Member Jan 1, 2021
Denise Rodney Individual Corporate DirectorBoard Member Jan 1, 2024
Maria Goeser Individual Corporate DirectorBoard Member Jan 1, 2021
Michael Greitzer Individual Corporate DirectorBoard Member Dec 1, 2009
Marvin Millan Narcelles Individual Corporate DirectorBoard Member Jan 1, 2019
Adam Groshans Individual Corporate DirectorBoard Member Jun 1, 2019
Truman Johnson Individual Corporate DirectorBoard Member Jan 1, 2018
Jenelle Zelinski Individual Corporate OfficerCfo May 20, 2019
Corporate DirectorBoard Member May 20, 2019
W-2 Managing EmployeeCfo May 20, 2019
James McGregor Individual Corporate DirectorBoard Member Jan 1, 2022
Lisa Cole Individual Corporate DirectorBoard Member Jan 1, 2020
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Sep 1, 2018 50%
Ryan Gilliam Individual Corporate DirectorBoard Member Jan 1, 2025
Nina Wiley Individual Corporate DirectorBoard Member Jan 1, 2020
Alexander Garvey Individual Corporate DirectorBoard Member Jan 1, 2023
John Starcher Individual Operational/Managerial ControlCho Admin Mar 16, 2016
Maryann Potina Individual Corporate DirectorBoard Member Jan 1, 2022
Adeleye a Edon Individual Corporate DirectorBoard Member Jan 1, 2022
The Community Hospital Health Services Foundation Organization, Springfield, OH Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2004 50%
Community Mercy Health System Organization, Springfield, OH Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2004 100%
William Ray Individual Corporate DirectorBoard Member Feb 1, 2015
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Apr 7, 2005
Joseph Gage Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Community Mercy Home CareSpringfield, OH, CCN 367447 Home health agency 5% Or Greater Direct Ownership Interest (50%) Oct 11, 2005

Owned or controlled facilities with NPI records 1

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

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 16

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 16

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": "1607990400000",
    "number": "1063066066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639761",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639761",
            "telephone_number": "513-952-5002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 PATRICK AVE",
            "city": "URBANA",
            "state": "OH",
            "postal_code": "430782302",
            "telephone_number": "937-484-6157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MERCY HEALTH PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-29",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR",
        "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": [
        {
            "organization_name": "MERCY HEALTH - URBANA HOSPITAL FAMILY MEDICINE AND PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Urbana, OH

Sources for this page

Verify at the official NPI Registry.