NPIMap

Organization Active NPI

Broaddus Hospital Association, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Philippi, WV
National Provider Identifier
1104989466
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
96 Issued in WV
Legal business name
BROADDUS HOSPITAL ASSOCIATION, INC.
Practice address
#1 Healthcare Drive
Mansfield Hill
Philippi, WV 26416
Phone
(304) 457-1760
Fax
(304) 457-1516
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Authorized official

Name
Mrs. Dana L. Gould
Title
Ceo
Phone
(304) 457-1760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 96 WV Primary

Addresses

Primary practice location

#1 Healthcare Drive
Mansfield Hill
Philippi, WV 26416

Mailing address

#1 Healthcare Drive
Mansfield Hill
Philippi, WV 26416
Phone (304) 457-1760

Other identifiers 1

IdentifierTypeStateIssuer
0002167001MedicaidWV

Other names 1

  • Broaddus Hospital (Swing Bed) Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220824000916 WV Part A Provider - Critical Access Hospital 5991692832 Receives reassigned benefits from 2 practitioners
Practice locations: Philippi, WV

Hospital certification: CCN 51Z300

Legal name
BROADDUS HOSPITAL ASSOCIATION INC.
Doing business as
DAVIS HEALTH SYSTEM
Organization structure
CorporationNon-profit
Enrollment address
#1 Healthcare Dr
Mansfield Hill
Philippi, WV 26416-1051
Main/Primary Hospital Location

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Vance M Jackson Individual Corporate DirectorPresident Dec 1, 2023
Dana Gould Individual Operational/Managerial ControlChief Executive Officer Sep 30, 2017
Kevin Shaffer Individual Corporate Officer Dec 1, 2023
William Koch Individual Contracted Managing Employee Dec 1, 2023
Corporate DirectorCfo Dec 1, 2023
Bridgette a Wilson Individual Corporate OfficerDHS Chair Dec 1, 2023
Mary Beth Lind Individual Corporate Director Jun 30, 2015
Donna Jean Phillips Individual Corporate Officer Jun 30, 2018
William Hartman Individual Corporate OfficerDHS Vice Chair Dec 1, 2023
Loretta J Wilson Individual Corporate Officer Jun 30, 2015
Crystal Dawn Gray Individual Corporate Officer Jun 30, 2018
Vandalia Health Inc Organization, Charleston, WV Corporation, Non-profit Operational/Managerial Control Dec 1, 2023 100%
Kevin M Gessler Individual Corporate Director Dec 1, 2023
Jeffrey D Sandene Individual Operational/Managerial Control Dec 1, 2023
Davis Health System Organization, Elkins, WV Corporation, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
Hugh Hitchcock Individual Corporate OfficerDHS Treasurer Dec 1, 2023
John Kabler Individual Corporate OfficerDHS Secretary Dec 1, 2023
Danny L Franke Individual Corporate DirectorDirector Jun 30, 2011
Jeffrey a Powelson Individual Corporate Director Jun 30, 2018

Owners & managing parties with NPI records 1

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

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 8

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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562630400000",
    "number": "1104989466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "#1 HEALTHCARE DRIVE",
            "address_2": "MANSFIELD HILL",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "26416",
            "telephone_number": "304-457-1760",
            "fax_number": "304-457-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "#1 HEALTHCARE DRIVE",
            "address_2": "MANSFIELD HILL",
            "city": "PHILIPPI",
            "state": "WV",
            "postal_code": "26416",
            "telephone_number": "304-457-1760",
            "fax_number": "304-457-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADDUS HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2019-07-09",
        "status": "A",
        "authorized_official_last_name": "GOULD",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-457-1760",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WV",
            "license": "96",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002167001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broaddus Hospital (Swing Bed)",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Broaddus Hospital (Swing Bed)",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Philippi, WV

Sources for this page

Verify at the official NPI Registry.