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Carthage Area Hospital Inc

Organization Active NPI Rural Health Clinic/Center · Philadelphia, NY

NPI 1124535604 · NPPES record last updated Feb 18, 2021

Key facts

NPI
1124535604
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
2238700C (NY)
Legal business name
CARTHAGE AREA HOSPITAL INC
Practice address
32787 US Route 11
Philadelphia, NY 13673
Phone
(315) 642-0216
Fax
(315) 654-0928
NPI assigned
Jan 5, 2018
Organization subpart
No

Authorized official

Name
Richard Duvall
Title
Ceo
Phone
(315) 519-5207

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 15

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

Corporate family (same tax ID) 31

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

View all 31

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

Practitioners 119

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

View all 119

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NY

Rural health clinic certification: CCN 333977

Legal name
CARTHAGE AREA HOSPITAL INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 21, 2018
Last certification
Nov 12, 2024
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Jun 1, 1965 in NY
Enrollment address
32787 US Route 11
Philadelphia, NY 13673
Related CCNs
331318

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Dale Klock
Individual 		Corporate Director
Governing Board Vice President		 May 1, 2010
Morgan Pierce
Individual 		Corporate Officer
VP of Finance		 Jan 1, 2023
Jerian O'Dell
Individual 		Corporate Officer
Coo		 Apr 2, 2023
Mirza M Ashraf
Individual 		Corporate Director May 1, 1992
Richard a Duvall
Individual 		Corporate Officer Nov 26, 2011
W-2 Managing Employee Nov 26, 2011
Anne Rohr
Individual 		Corporate Director May 1, 2010
Tim Sturick
Individual 		Corporate Director
Governing Board Treasurer		 May 1, 2016
Kenneth J Fish
Individual 		Corporate Director May 1, 2002
Gary Rowe
Individual 		Corporate Director
Governing Board President		 May 1, 2007
Patti Earl
Individual 		Corporate Director
Board Member		 Jan 1, 2023
Adam Fuller
Individual 		Corporate Director May 1, 2013
Larry Hasseler
Individual 		Corporate Director
Governing Board Secretary		 May 1, 2006
Jennifer Premo
Individual 		Corporate Director
Board Member		 Jan 1, 2023

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20180417001337 NY Part a Provider - Rural Health Clinic 9931010485 Practice locations: Philadelphia, NY

National Provider Directory

Tax ID family
Carthage Area Hosp (32 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 2238700C NY Yes

Addresses

Primary practice location

32787 US Route 11
Philadelphia, NY 13673

Mailing address

1001 West St
Carthage, NY 13619-9703
Phone (315) 493-1000

Other providers in Philadelphia, NY

All providers in Philadelphia, NY · Rural Health Clinic/Center in New York

Sources for this page

Verify at the official NPI Registry.