NPIMap

Organization Active NPI

Adams County Regional Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Seaman, OH
National Provider Identifier
1114575560
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Practice address
230 Medical Center Dr
Seaman, OH 45679-8002
Phone
(937) 386-3400
Fax
(937) 386-3019
NPI assigned
Aug 29, 2019
Last updated
Jun 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

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

Authorized official

Name
Pete R Dagenbach
Title
Cfo
Phone
(937) 386-3400

Specialties & licenses 1

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

Addresses

Primary practice location

230 Medical Center Dr
Seaman, OH 45679-8002

Mailing address

230 Medical Center Dr
Seaman, OH 45679-8002
Phone (937) 386-3400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191203001324 OH Part A Provider - Critical Access Hospital 8921431131 Practice locations: Seaman, OH
O20200427002166 OH Part B Supplier - Clinic/Group Practice 8921431131 Receives reassigned benefits from 47 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, OH; Seaman, OH; West Union, OH; Winchester, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114575560. Details of each certification follow.

Hospital certification: CCN 36Z326

Legal name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
May 31, 2016 in OH
Enrollment address
230 Medical Center Dr
Seaman, OH 45679-8002
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Adams County Regional Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the 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
Pete R Dagenbach Individual W-2 Managing EmployeeChief Financial Officer Oct 1, 2019
Matthew a Armstrong Individual Corporate DirectorDirector Oct 1, 2019
Alan Bird Individual Corporate OfficerChief Executive Officer Oct 1, 2019
Corporate Director Oct 1, 2019
Peoples Bank National Association Organization, Marietta, OH Financial institution 5% Or Greater Mortgage Interest Sep 30, 2024 80.7%
Peggy Chalker Individual Corporate DirectorDirector Oct 1, 2019
Jack a McCoy Individual Corporate DirectorDirector Oct 1, 2019
Chad Wilson Individual Corporate DirectorDirector Oct 1, 2019
Roy Gustin Individual Corporate DirectorDirector Oct 1, 2019

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Acrmc Family MedicineWinchester, OH, CCN 363431 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

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.

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": "1567036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1114575560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 MEDICAL CENTER DR",
            "city": "SEAMAN",
            "state": "OH",
            "postal_code": "456798002",
            "telephone_number": "937-386-3400",
            "fax_number": "937-386-3019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 MEDICAL CENTER DR",
            "city": "SEAMAN",
            "state": "OH",
            "postal_code": "456798002",
            "telephone_number": "937-386-3400",
            "fax_number": "937-386-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS COUNTY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-29",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "DAGENBACH",
        "authorized_official_first_name": "PETE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-386-3400"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seaman, OH

Sources for this page

Verify at the official NPI Registry.