NPIMap

Organization Active NPI

Bucyrus Community Hospital LLC

Doing business as Bucyrus Community Hospital

  • Critical Access Hospital
  • Bucyrus, OH
National Provider Identifier
1104914274
Registry record updated Apr 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
BUCYRUS COMMUNITY HOSPITAL LLC
Doing business as
Bucyrus Community Hospital
Practice address
629 N Sandusky Ave
Bucyrus, OH 44820
Phone
(419) 562-4677
NPI assigned
Oct 11, 2006
Last updated
Apr 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2013

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

Authorized official

Name
Mr. D. Eric Draime
Title
Chief Financial Officer
Phone
(419) 468-0501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

629 N Sandusky Ave
Bucyrus, OH 44820

Mailing address

629 N Sandusky Ave
Bucyrus, OH 44820

Other identifiers 3

IdentifierTypeStateIssuer
000000156740OtherANTHEM
1112843MedicaidOH
344468311030OtherMEDICAL MUTUAL OF OHIO

Other names 1

  • Bucyrus Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110520000287 OH Part A Provider - Critical Access Hospital 0749460673 Receives reassigned benefits from 18 practitioners
Practice locations: Bucyrus, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104914274. Details of each certification follow.

Hospital certification: CCN 361316

Legal name
BUCYRUS COMMUNITY HOSPITAL, LLC
Doing business as
BUCYRUS COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Dec 12, 2003
Beds
15
Ownership / control type
Other
Most recent change of ownership
Jan 1, 2011 (1 total)
Organization structure
LLCNon-profit
Incorporated
Nov 24, 2010 in OH
Enrollment address
629N Sandusky Ave
Bucyrus, OH 44820-1821

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Bucyrus Community HospitalCCN 361316 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

775 Lexington Ave
Mansfield, OH 44907
Phone (419) 756-2525

2170 Stumbo Rd
Ontario, OH 44906
Phone (419) 689-2763

715 Richland Mall
#M
Ontario, OH 44906
Phone (419) 468-0511

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Donald Barr Individual Corporate DirectorBoard Member Dec 31, 2010
Jeffrey Underwood Individual Corporate DirectorBoard Member Jan 1, 2014
Michael Kemerer Individual Corporate DirectorBoard Member Apr 1, 2024
Mark Schneider Individual Corporate Director Dec 31, 2010
Kymberly Fox Individual Corporate DirectorBoard Member Dec 31, 2010
Kay E McDonald Individual Corporate DirectorBoard Member Dec 31, 2010
Linda Smith Individual Corporate DirectorBoard Member Jan 30, 2014
Galion Community Hospital Organization, Galion, OH Corporation 5% Or Greater Direct Ownership Interest Dec 31, 2010 100%
Charles Walker Individual Corporate DirectorBoard Member Dec 31, 2010
Jerome B Morasko Individual Corporate OfficerCeo Dec 31, 2010
Philip M Brown Individual Corporate DirectorBoard Member Dec 31, 2010
Joseph Shadeed Individual Corporate DirectorBoard Member Jan 1, 2010
Donald E Draime Individual Corporate OfficerCfo Dec 31, 2010
W-2 Managing Employee Dec 31, 2010
Douglas Schilling Individual Corporate DirectorBoard Member Dec 31, 2010
Jason R McMullen Individual Corporate DirectorBoard Member Jan 1, 2010
Donald Plotts Individual Corporate DirectorBoard Member Jan 1, 2014

Owners & managing parties with NPI records 17

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

View all 17

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 61

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 61

Affiliated clinicians 182

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

View all 182

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366761600000",
    "number": "1104914274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "44820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 N SANDUSKY AVE",
            "city": "BUCYRUS",
            "state": "OH",
            "postal_code": "44820",
            "telephone_number": "419-562-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCYRUS COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2013-04-24",
        "status": "A",
        "authorized_official_last_name": "DRAIME",
        "authorized_official_first_name": "D.",
        "authorized_official_middle_name": "ERIC",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "419-468-0501",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000156740",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1112843",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL OF OHIO",
            "identifier": "344468311030",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bucyrus Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bucyrus, OH

Sources for this page

Verify at the official NPI Registry.