NPIMap

Organization Active NPI

Carthage Area Hospital, Inc.

  • Critical Access Hospital
  • Carthage, NY
National Provider Identifier
1104234376
Registry record updated Nov 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
2238700C Issued in NY
Legal business name
CARTHAGE AREA HOSPITAL, INC.
Practice address
1001 West St
Carthage, NY 13619-9703
Phone
(315) 493-1000
Fax
(315) 493-0105
NPI assigned
Jul 31, 2014
Last updated
Nov 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2020

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

Authorized official

Name
Richard Duvall
Title
Ceo Administrator
Phone
(315) 519-5201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 2238700C NY Primary

Addresses

Primary practice location

1001 West St
Carthage, NY 13619-9703

Mailing address

1001 West St
Carthage, NY 13619-9703
Phone (315) 519-5724

Other identifiers 1

IdentifierTypeStateIssuer
03000662MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209000856 NY Part B Supplier - Clinic/Group Practice 9931010485 Receives reassigned benefits from 250 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waddington, NY; Philadelphia, NY; Ogdensburg, NY; Heuvelton, NY; Hammond, NY; Carthage, NY; Canton, NY; Madrid, NY
O20140523000720 NY Part A Provider - Critical Access Hospital 9931010485 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
Practice locations: Carthage, NY; Philadelphia, NY; Beaver River, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104234376. Details of each certification follow.

Hospital certification: CCN 331318

Legal name
CARTHAGE AREA HOSPITAL INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 2, 2014
Last certification
Oct 5, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 1967 in NY
Enrollment address
1001 West St
Carthage, NY 13619-9703

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

View all 13

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 16

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

View all 16

Care Compare: Hospital

Medicare Care Compare
Listed as
Carthage Area Hospital, IncCCN 331318 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dale Klock Individual Corporate DirectorGoverning Board Vice President May 1, 2010
Andrew R Manzer Individual Corporate OfficerInterim Ceo Mar 2, 2026
W-2 Managing EmployeeAd; Mar 2, 2026
Arnold R Hager Individual Corporate OfficerVP of Revenue Cycle Oct 1, 2025
Jerian O'Dell Individual Corporate OfficerCoo Apr 2, 2023
W-2 Managing EmployeeAd; Jan 1, 2026
Mirza M Ashraf Individual Corporate DirectorBoard of Directors May 1, 1992
Tim Sturick Individual Corporate DirectorGoverning Board Treasurer May 1, 2016
Gary Rowe Individual Corporate DirectorGoverning Board President May 1, 2007
Larry Hasseler Individual Corporate DirectorGoverning Board Secretary May 1, 2006

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 76

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 76

Affiliated clinicians 155

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

View all 155

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606262400000",
    "number": "1104234376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST ST",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136199703",
            "telephone_number": "315-519-5724",
            "fax_number": "315-493-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 WEST ST",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136199703",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE AREA HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO ADMINISTRATOR",
        "authorized_official_telephone_number": "315-519-5201"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NY",
            "license": "2238700C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03000662",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, NY

Sources for this page

Verify at the official NPI Registry.