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Montgomery General Hospital, Inc.

Organization Active NPI General Acute Care Hospital · Olney, MD

NPI 1114922341 · NPPES record last updated Oct 26, 2007

Key facts

NPI
1114922341
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
15-202 (MD)
Legal business name
MONTGOMERY GENERAL HOSPITAL, INC.
Practice address
18101 Prince Philip Dr
Olney, MD 20832-1514
Phone
(301) 774-8649
Fax
(301) 774-9676
NPI assigned
Jun 15, 2005
Organization subpart
No

Authorized official

Name
Mr. John Hogarty
Title
Sr. Vice President/ Cfo
Phone
(301) 774-8649

Owners & managing parties with NPI records 5

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

Corporate family (same tax ID) 1

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

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Facilities with the same owner 13

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

Practitioners 40

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

View all 40

Affiliated clinicians 392

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

View all 392

Medicare Care Compare: Hospital

Listed as
Medstar Montgomery Medical Center CCN 210018
Overall star rating
★★★☆☆ 3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D0212005Medstar Montgomery Medical Center Laboratory
18101 Prince Philip Drive, Olney, MD 20832		AccreditationFeb 27, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

Hospital certification: CCN 210018

Legal name
MONTGOMERY GENERAL HOSPITAL INC
Doing business as
MEDSTAR MONTGOMERY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 27, 2010
Beds
165
Ownership / control type
Private (not for profit)
Organization structure
Corporation · Non-profit
Incorporated
Jun 11, 1918 in MD
Enrollment address
18101 Prince Philip Dr
Olney, MD 20832-1514
Other Hospital Practice Location
Hospital subgroups
Acute care

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Carolina Chavarria
Individual 		Corporate Officer
Secretary		 Mar 2, 2016
Montgomery General Hospital Inc
Organization · Olney, MD
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Feb 1, 2008 100%
Deborah Ellinghaus
Individual 		Corporate Director
Board Member		 Nov 1, 2016
David Havrilla
Individual 		Corporate Officer
Treasurer		 Jul 1, 2009
W-2 Managing Employee
Cfo/VP of Finance		 Jul 1, 2009
Operational/Managerial Control
Cfo/VP of Finance		 Jul 1, 2009
Steven Marc Shimoura
Individual 		Corporate Director
Board Member		 Nov 1, 2014
Alok Mathur
Individual 		Corporate Director
Board Member		 Nov 1, 2014
Thomas J. Senker
Individual 		Corporate Officer
President		 Mar 1, 2016
Corporate Director
Board Member		 Mar 1, 2016
W-2 Managing Employee
President		 Mar 1, 2016
Operational/Managerial Control
President		 Mar 1, 2016
Tasha Cerjanic
Individual 		W-2 Managing Employee
Director of Finance		 Aug 16, 2021
Marc L Kozam
Individual 		Corporate Director
Board Member		 Nov 1, 2018
Kenneth a Samet
Individual 		Corporate Director
Board Member		 Feb 1, 2008
Neil Roy Ohora
Individual 		Corporate Director
Board Member		 Nov 1, 2018
Richard Hoffman
Individual 		Corporate Director
Board Member		 Nov 1, 2017
John Ferguson
Individual 		Corporate Director
Board Member		 Nov 1, 2009
Gary Fernandes
Individual 		Corporate Director
Board Member		 Nov 1, 2018
Katherine Farquhar
Individual 		Corporate Director
Board Member		 Nov 1, 2012
Richard Weinstein
Individual 		Corporate Director
Board Member		 Nov 1, 2011
Sujithra Jayaraj-Sudarsan
Individual 		Corporate Director
Board Member		 Nov 1, 2015
Christine Hill Wilson
Individual 		Corporate Director
Board Member		 Dec 1, 2020
Medstar Health, Inc.
Organization · Columbia, MD
Corporation, Non-profit 		5% Or Greater Indirect Ownership Interest Feb 1, 2008 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20071126000444 MD Part a Provider - Hospital 1254315419 Practice locations: Olney, MD

National Provider Directory

Tax ID family
Montgomery General Hospital (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 15-202 MD Yes

Addresses

Primary practice location

18101 Prince Philip Dr
Olney, MD 20832-1514

Mailing address

18101 Prince Philip Dr
Olney, MD 20832-1514

Other identifiers

IdentifierTypeStateIssuer
O20719200OtherDCDC MEDICAID
5000047OtherMDUNITED HEALTH MCO
234094OtherMDALLIANCE PPO
5000047OtherMDUNITED HEALTHCARE
734OtherMDBCBS NATIONAL ACCOUNTS
OOO315800OtherMDMAPS MD
104272OtherMHKAISER
45833OtherMDAMERICAID MCO
235094OtherMDUFCW/FELRA
57355901OtherMDCAREFIRST OF MD
9992OtherMDAETNA
4235094OtherMDMDIPA

Other providers in Olney, MD

All providers in Olney, MD · General Acute Care Hospital in Maryland

Sources for this page

Verify at the official NPI Registry.