NPIMap

Organization Active NPI

Jefferson Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Ranson, WV
National Provider Identifier
1104242569
Registry record updated Feb 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
JEFFERSON MEMORIAL HOSPITAL
Practice address
300 S Preston St
Ranson, WV 25438-1631
Phone
(304) 728-1669
Fax
(304) 725-9492
NPI assigned
Mar 10, 2014
Last updated
Feb 10, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST VIRGINIA UNIVERSITY HOSPITALS - EASTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2017

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

Authorized official

Name
Anthony P. Zelenka
Title
President & Ceo
Phone
(304) 264-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

300 S Preston St
Ranson, WV 25438-1631

Mailing address

PO Box 1170
Morgantown, WV 26507-1170
Phone (304) 264-1358

Other names 1

  • Jefferson Medical Center Transitional Care Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220915003044 WV Part A Provider - Critical Access Hospital 0446151989 Receives reassigned benefits from 1 practitioner
Practice locations: Ranson, WV
O20230202001687 WV Part A Provider - Critical Access Hospital 0446151989 Receives reassigned benefits from 115 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ranson, WV

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1104242569. Details of each certification follow.

Hospital certification: CCN 51Z319

Legal name
JEFFERSON MEMORIAL HOSPITAL
Doing business as
JMC TRANSITIONAL CARE SERVICES
Organization structure
CorporationNon-profit
Enrollment address
300 S Preston St
Ranson, WV 25438-1631
Main/Primary Hospital Location

Hospital certification: CCN 511319

Legal name
JEFFERSON MEMORIAL HOSPITAL
Doing business as
JEFFERSON MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 15, 2005
Last certification
Jan 31, 2018
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 26, 1912 in WV
Enrollment address
300 S Preston St
Ranson, WV 25438-1631
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson Medical CenterCCN 511319 · All quality measures
Overall star rating
1 of 5
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

Locations

201 S Fairfax Blvd
Ranson, WV 25438
Phone (304) 598-4482

304 S Preston St
Jefferson Orthopedics
Ranson, WV 25438
Phone (304) 725-6561

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Albert Wright Individual Corporate DirectorWvuh President/Ceo Feb 1, 2022
Corporate Director Feb 1, 2022
Susan Snowden Individual Corporate DirectorBoard Member Feb 4, 2019
Corporate Director Feb 4, 2019
Charles Lynch Christian Individual Corporate DirectorBoard Member Jun 2, 2026
Charles W Hensell Individual Corporate DirectorBoard Member Jun 2, 2026
Heshm Bakr Individual Corporate DirectorBoard Member Jun 2, 2026
Alice Frazier Individual Corporate DirectorBoard Member Feb 4, 2019
Corporate Director Feb 4, 2019
West Virginia University Hospitals East Inc Organization, Martinsburg, WV Non-profit Operational/Managerial Control Jan 1, 2005
Mark Graves Individual Corporate DirectorBoard Member Jun 2, 2026
Justin Henry Individual Corporate DirectorBoard Member Jun 2, 2026
Grover Zach Kerns Individual Corporate OfficerCfo Jan 25, 2019
W-2 Managing EmployeeCfo Jan 25, 2019
W-2 Managing EmployeeVP of Fin Jan 25, 2019
West Virginia United Health System, Inc Organization, Fairmont, WV Non-profit Operational/Managerial Control Jan 1, 2005
Samantha Richards Individual W-2 Managing EmployeeCoo Jun 2, 2026
Richard William Thomas Individual Corporate DirectorBoard Member Jun 2, 2026
Richard J. Ward Individual Corporate DirectorBoard Member Jun 2, 2026
Douglas Scott Roach Individual Corporate DirectorBoard Member Jun 2, 2026
Corporate OfficerTreasurer Jan 1, 2011
Henry Kayes Individual Corporate DirectorBoard Member Jan 1, 2017
Corporate DirectorBoard of Dir Jan 1, 2017
Carrie E Willetts Individual Corporate DirectorBoard Member Jun 2, 2026
Nicole Dollison Individual Corporate OfficerPresident & Ceo Jun 2, 2026
W-2 Managing EmployeePresident & Ceo Jun 2, 2026
Margaret M Cogswell Individual Corporate DirectorBoard Member Jun 2, 2026
David Deuell Individual Corporate DirectorBoard Member Jun 2, 2026
Brian Romine Individual Corporate Director Jan 1, 2017
Dean Thomas Individual W-2 Managing EmployeePres / Ceo Jan 1, 2021
Chiquita Howard-Bostic Individual Corporate Director Aug 1, 2015
Deborah Burge Individual W-2 Managing Employee Jun 1, 2021
James Rogers Individual Corporate Director Apr 2, 2018
Dawn R Jones Individual Corporate Director May 26, 2015
Jackee Long Individual Corporate Director Jan 1, 2012
Michael S Londner Individual Corporate Director Jan 1, 2021
Marney B Treese Individual Corporate Director Feb 4, 2019
Emma Morton-Eggleston Individual Corporate Director Jan 1, 2017
Michael Edmond Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 8

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 140

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 140

Affiliated clinicians 337

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

View all 337

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1104242569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1170",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265071170",
            "telephone_number": "304-264-1358",
            "fax_number": "304-260-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S PRESTON ST",
            "city": "RANSON",
            "state": "WV",
            "postal_code": "254381631",
            "telephone_number": "304-728-1669",
            "fax_number": "304-725-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST VIRGINIA UNIVERSITY HOSPITALS - EAST",
        "enumeration_date": "2014-03-10",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "ZELENKA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "304-264-1000"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson Medical Center Transitional Care Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ranson, WV

Sources for this page

Verify at the official NPI Registry.