NPIMap

Selby General Hospital

Organization Active NPI Critical Access Hospital · Marietta, OH

NPI 1124073465 · NPPES record last updated Jan 22, 2021

Key facts

NPI
1124073465
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 9

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

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.

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

Practitioners 274

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

View all 274

Affiliated clinicians 294

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

View all 294

Medicare Care Compare: Hospital

Listed as
Selby General Hospital CCN 361319
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in OH

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
Corporation · Non-profit
Incorporated
May 12, 1939 in OH
Enrollment address
1106 Colegate Dr
Marietta, OH 45750-1323
Other Hospital Practice Location

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 Director
Treasurer Board of Directors		 Jan 1, 2014
Sheryl Holdren
Individual 		Corporate Director
Board of Directors		 Jan 1, 2017
Terry E Rataiczak
Individual 		Corporate Director
Board of Directors		 Jan 1, 2019
Carol a Schneeberger
Individual 		Corporate Director
Board of Directors		 Jan 1, 2020
Michael Iaderosa
Individual 		Corporate Director
Board of Directors		 Oct 1, 2002
Victoria McGee
Individual 		W-2 Managing Employee
Provider Enrollment Supervisor		 May 5, 2014
Joseph D Cooper
Individual 		Corporate Director
Secretary Board of Directors		 Jan 1, 2003
Rebekah Gilden
Individual 		W-2 Managing Employee
Compliance and Privacy Coordinator		 Sep 1, 2018
Paul G Westbrock
Individual 		Corporate Officer
General Counsel		 Jun 1, 2000
Larry Unroe
Individual 		Corporate Director
Board of Directors		 Jan 1, 2015
Colleen Cook
Individual 		Corporate Director
Board of Directors		 Jan 1, 2010
Elizabeth a Helmick
Individual 		Corporate Director
Board of Directors		 Feb 1, 2021
Christopher Alexander Cockerham
Individual 		Corporate Director
Board of Director		 Jan 1, 2020
Jody Lynn Bullman
Individual 		Corporate Officer
President		 Jan 1, 2001
Thomas Danford
Individual 		Corporate Director
Board of Directors		 Jan 1, 2005
Scott Silvestri
Individual 		Corporate Officer
Cfo		 May 1, 2019
Michael Archer
Individual 		Corporate Director
Chairperson Board of Directors		 Jan 1, 2005
Gregg M Emerick
Individual 		Corporate Director
Board of Directors		 Jan 1, 2019
Stephen C Keiser
Individual 		Corporate Director
Vice Chairperson Board of Directors		 Jan 1, 2019
John Lee
Individual 		Corporate Director
Board of Directors		 Jan 1, 2015

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Yes

Addresses

Primary practice location

1106 Colegate Dr
Marietta, OH 45750-1323

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
7943257MedicaidOH
0001482000MedicaidWV

Electronic endpoints

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 22, 2021.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7943257",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001482000",
            "state": "WV"
        }
    ],
    "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

All providers in Marietta, OH · Critical Access Hospital in Ohio

Sources for this page

Verify at the official NPI Registry.