NPIMap

Organization Active NPI

Selby General Hospital

  • Critical Access Hospital
  • Marietta, OH
National Provider Identifier
1124073465
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
SELBY GENERAL HOSPITAL
Practice address
1106 Colegate Dr
Marietta, OH 45750-1323
Phone
(740) 568-2040
Fax
(740) 568-2089
NPI assigned
May 24, 2006
Last updated
Jan 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Paige Smith
Title
President
Phone
(740) 568-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1106 Colegate Dr
Marietta, OH 45750-1323

Mailing address

1106 Colegate Dr
Marietta, OH 45750-1323
Phone (740) 568-2048

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hospital.provider@mmhs.medicity.net

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000165 OH Part B Supplier - Clinic/Group Practice 9638087893 Receives reassigned benefits from 109 practitioners
12 other NPIs on this enrollment
Practice locations: Athens, OH; Waterford, OH; Vincent, OH; Marietta, OH; Logan, OH; Caldwell, OH
O20081002000000 OH Part A Provider - Critical Access Hospital 9638087893 Receives reassigned benefits from 263 practitioners
Practice locations: Marietta, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124073465. Details of each certification follow.

Hospital certification: CCN 361319

Legal name
SELBY GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2003
Last certification
Aug 1, 2013
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 12, 1939 in OH
Enrollment address
1106 Colegate Dr
Marietta, OH 45750-1323
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Selby General HospitalCCN 361319 · All quality measures
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

Locations

1106 Colegate Dr
Marietta, OH 45750
Phone (740) 374-7700

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
James Barengo Individual Corporate DirectorTreasurer Board of Directors Jan 1, 2014
Sheryl Holdren Individual Corporate DirectorBoard of Directors Jan 1, 2017
Terry E Rataiczak Individual Corporate DirectorBoard of Directors Jan 1, 2019
Carol a Schneeberger Individual Corporate DirectorBoard of Directors Jan 1, 2020
Michael Iaderosa Individual Corporate DirectorBoard of Directors Oct 1, 2002
Victoria McGee Individual W-2 Managing EmployeeProvider Enrollment Supervisor May 5, 2014
Joseph D Cooper Individual Corporate DirectorSecretary Board of Directors Jan 1, 2003
Rebekah Gilden Individual W-2 Managing EmployeeCompliance and Privacy Coordinator Sep 1, 2018
Paul G Westbrock Individual Corporate OfficerGeneral Counsel Jun 1, 2000
Larry Unroe Individual Corporate DirectorBoard of Directors Jan 1, 2015
Colleen Cook Individual Corporate DirectorBoard of Directors Jan 1, 2010
Elizabeth a Helmick Individual Corporate DirectorBoard of Directors Feb 1, 2021
Christopher Alexander Cockerham Individual Corporate DirectorBoard of Director Jan 1, 2020
Jody Lynn Bullman Individual Corporate OfficerPresident Jan 1, 2001
Thomas Danford Individual Corporate DirectorBoard of Directors Jan 1, 2005
Scott Silvestri Individual Corporate OfficerCfo May 1, 2019
Michael Archer Individual Corporate DirectorChairperson Board of Directors Jan 1, 2005
Gregg M Emerick Individual Corporate DirectorBoard of Directors Jan 1, 2019
Stephen C Keiser Individual Corporate DirectorVice Chairperson Board of Directors Jan 1, 2019
John Lee Individual Corporate DirectorBoard of Directors Jan 1, 2015

Owners & managing parties with NPI records 3

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

Subparts reporting this organization as parent 11

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 274

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 274

Affiliated clinicians 294

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

View all 294

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1124073465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501323",
            "telephone_number": "740-568-2048",
            "fax_number": "740-568-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501323",
            "telephone_number": "740-568-2040",
            "fax_number": "740-568-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELBY GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-568-2000"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hospital.provider@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "1106 Colegate Dr",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marietta, OH

Sources for this page

Verify at the official NPI Registry.