NPIMap

Organization Active NPI

St Josephs Hospital of Buckhannon Inc

  • Critical Access Hospital
  • Buckhannon, WV
National Provider Identifier
1124005061
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
ST JOSEPHS HOSPITAL OF BUCKHANNON INC
Practice address
1 Amalia Dr
Buckhannon, WV 26201-2239
Phone
(304) 473-2000
Fax
(304) 473-2180
NPI assigned
Dec 30, 2005
Last updated
Oct 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Authorized official

Name
Sue E Johnson-Phillippe, FACHE
Title
Ceo
Phone
(304) 473-2118

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary
Rural Acute Care Hospital 282NR1301X 87 WV
Durable Medical Equipment & Medical Supplies 332B00000X 87 WV
Durable Medical Equipment & Medical Supplies 332B00000X NU

Addresses

Primary practice location

1 Amalia Dr
Buckhannon, WV 26201-2239

Mailing address

1 Amalia Dr
Buckhannon, WV 26201-2239
Phone (304) 473-2000

Other identifiers 2

IdentifierTypeStateIssuer
510053OtherFORMER CCN
0001139000MedicaidWV

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com Other
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050525000839 WV Part B Supplier - Clinic/Group Practice 6709828163 Receives reassigned benefits from 199 practitioners
Practice locations: Weston, WV; Thomas, WV; Sutton, WV; Mill Creek, WV; Buckhannon, WV; Elkins, WV
O20220914000951 WV Part A Provider - Critical Access Hospital 6709828163 Receives reassigned benefits from 1 practitioner
Practice locations: Buckhannon, WV
O20230204000431 WV Part A Provider - Critical Access Hospital 6709828163 Receives reassigned benefits from 200 practitioners
Practice locations: Buckhannon, WV

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1124005061. Details of each certification follow.

Hospital certification: CCN 51Z321

Legal name
ST JOSEPH'S HOSPITAL OF BUCKHANNON INC
Doing business as
ST JOSEPH'S HOSPITAL
Organization structure
CorporationProprietary
Enrollment address
1 Amalia Dr
Buckhannon, WV 26201-2239
Other Hospital Practice Location

Hospital certification: CCN 511321

Legal name
ST JOSEPH'S HOSPITAL OF BUCKHANNON INC
Doing business as
ST JOSEPH'S HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 2, 2014
Last certification
Apr 2, 2014
Beds
51 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1 Amalia Dr
Buckhannon, WV 26201-2239
Main/Primary Hospital Location

Hospital certification: CCN 510053

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ST JOSEPH HOSPITAL
Certification status
Terminated Other: provider status change, Apr 1, 2014
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 20, 2009
Beds
95
Ownership / control type
Church
Facility address
1 Amalia Drive
Buckhannon, WV 26201

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Joseph's Hospital of Buckhannon, IncCCN 511321 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
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.

Member organizations 3

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

Locations

1 Amalia Dr
Ste 310
Buckhannon, WV 26201
Phone (304) 473-2200

10 Amalia Dr
#A
Buckhannon, WV 26201
Phone (304) 473-2200

10 Amalia Dr
Ste C3
Buckhannon, WV 26201
Phone (304) 472-2100

10 Amalia Dr
Ste C4
Buckhannon, WV 26201
Phone (304) 460-7936

10 Amalia Dr
Ste C5
Buckhannon, WV 26201
Phone (304) 460-7040

10 Amalia Dr
Ste C6
Buckhannon, WV 26201
Phone (304) 473-2303

10 Amalia Dr
Ste C7
Buckhannon, WV 26201
Phone (304) 460-7979

10 Amalia Dr
Ste C8
Buckhannon, WV 26201
Phone (304) 460-7959

102 Pallottine Dr
Buckhannon, WV 26201
Phone (304) 460-7455

17 N Spring St
Buckhannon, WV 26201
Phone (304) 460-7960

21 Auction Ln
Ste B
Buckhannon, WV 26201
Phone (304) 460-7925

81 S Kanawha St
Buckhannon, WV 26201
Phone (304) 472-7782

94 W Main St
Ste 101
Buckhannon, WV 26201
Phone (304) 473-2202

94 W Main St
Ste 102
Buckhannon, WV 26201
Phone (304) 460-7935

94 W Main St
Ste 202
Buckhannon, WV 26201
Phone (304) 460-7925

124 Chenoweth Creek Rd
Elkins, WV 26241
Phone (304) 636-9610

201 Main St
Ste D
Elkins, WV 26241
Phone (304) 473-2000

107 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022

149 Staunton Dr
Weston, WV 26452
Phone (304) 269-2022

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Ivar H Gjolberg Individual Corporate Director Apr 13, 2016
W-2 Managing Employee Apr 13, 2016
Robert Xander Individual Corporate Director Apr 1, 2009
Michael C. Tillman Individual Corporate Director Oct 1, 2015
Deborah Burge Individual W-2 Managing EmployeeMGR ENT Patient Fin SVCS Jun 1, 2021
Katherine Wagner Individual Corporate Director Oct 1, 2015
John K Bohman Individual Corporate Director Nov 1, 2020
Corporate DirectorBoard Member Nov 1, 2020
United Hospital Center, Inc. Organization, Bridgeport, WV Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2015
Robert P Romano Individual Corporate Director Jan 1, 2022
Russell L. Plywaczynski Individual W-2 Managing Employee May 16, 2017
Francesca Lowis Individual Corporate Director Nov 4, 2008
Samuel Nolte Individual Corporate Director Jan 19, 2017
Donald B Nestor Individual Corporate Director Nov 1, 2017
Corporate DirectorBoard Member Nov 1, 2017
Donovan Hanifan Individual Corporate Director Jul 26, 2017
Corporate DirectorBoard Member Jul 1, 2017
Bartley Brown Individual Corporate Director Jan 1, 2016
Corporate DirectorBoard Member Jan 1, 2018
David F Hess Individual Corporate DirectorBoard Member Mar 1, 2026
Burton L Abel Individual Corporate DirectorBoard Member Mar 1, 2026
Forest Hannah Individual Corporate OfficerCfo Mar 1, 2026
W-2 Managing EmployeeCfo Mar 1, 2026
Brandon Tenney Individual Corporate DirectorBoard Member Mar 1, 2026
Danielle C Ware Individual Corporate DirectorBoard Member Mar 1, 2026
West Virginia United Health System, Inc Organization, Morgantown, WV Non-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2024 100%
Keith Buchanan Individual Corporate DirectorBoard Member Dec 1, 2024
John C Forester Individual Corporate DirectorPresident Mar 1, 2026
W-2 Managing EmployeePresident Mar 1, 2026
Danuta Pryzbylek Individual Corporate DirectorBoard Member Dec 1, 2024
Kelley Tierney Individual Corporate DirectorBoard Member Dec 1, 2024

Owners & managing parties with NPI records 5

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 228

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 228

Affiliated clinicians 381

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

View all 381

NPI Registry JSON

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1124005061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 AMALIA DR",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012239",
            "telephone_number": "304-473-2000",
            "fax_number": "304-473-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AMALIA DR",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262012239",
            "telephone_number": "304-473-2000",
            "fax_number": "304-473-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPHS HOSPITAL OF BUCKHANNON INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-PHILLIPPE",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-473-2118",
        "authorized_official_credential": "FACHE"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "WV",
            "license": "87",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WV",
            "license": "87",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FORMER CCN",
            "identifier": "510053",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001139000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Parkway",
            "address_2": "Suite 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "21044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Buckhannon, WV

Sources for this page

Verify at the official NPI Registry.