NPIMap

Organization Active NPI

Crestview Hospital Company, LLC

  • General Acute Care Hospital
  • Crestview, FL
National Provider Identifier
1104897859
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4298 Issued in FL
Legal business name
CRESTVIEW HOSPITAL COMPANY, LLC
Practice address
151 E Redstone Ave
Crestview, FL 32539-5352
Phone
(850) 689-8100
NPI assigned
Jan 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Paula Lalor
Title
Director
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 4298 FL Primary

Addresses

Primary practice location

151 E Redstone Ave
Crestview, FL 32539-5352

Mailing address

PO Box 198002
Atlanta, GA 30384-8002

Other identifiers 3

IdentifierTypeStateIssuer
426OtherBCBS
010126500MedicaidFL
HOS0122PMedicaidAL

Other names 1

  • NORTH OKALOOSA MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070910000373 FL Part A Provider - Hospital 3678472313 Practice locations: Crestview, FL

Hospital certification: CCN 100122

Legal name
CRESTVIEW HOSPITAL COMPANY LLC
Doing business as
NORTH OKALOOSA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 11, 1978
Last certification
May 6, 2010
Beds
110
Ownership / control type
Private (not for profit)
Organization structure
LLCProprietary
Enrollment address
151 E Redstone Ave
Crestview, FL 32539-5352
Main/Primary Hospital Location
Hospital subgroups
Acute care

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).

National Provider Directory

National Provider Directory
Tax ID family
Gateway Medical Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kevin J Hammons Individual Corporate OfficerPresident/Board Member Mar 1, 2022
Corporate DirectorPresident/Board Member Mar 1, 2022
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Jul 15, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
Michael B Nordness Individual W-2 Managing EmployeeCeo Jan 17, 2022
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 1, 2007 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Paula M Lalor Individual Corporate DirectorDirector PFS/Delegated Official Apr 8, 2017
North Okaloosa Medical Company LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Feb 17, 2023 100%
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Community Health Investment Company LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2007 100%
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 26, 2013
CHS Community Health Systems Inc Organization, Franklin, TN Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2007 100%

Facilities with the same owner 120

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

View all 120

Practitioners 4

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

Affiliated clinicians 292

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

View all 292

Care Compare: Hospital

Medicare Care Compare
Listed as
North Okaloosa Medical CenterCCN 100122
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1104897859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 198002",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303848002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 E REDSTONE AVE",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395352",
            "telephone_number": "850-689-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW HOSPITAL COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "FL",
            "license": "4298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "426",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010126500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HOS0122P",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTH OKALOOSA MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

Verify at the official NPI Registry.