NPIMap

Organization Active NPI

Carthage Area Hospital Inc

  • Rural Health Clinic/Center
  • Philadelphia, NY
National Provider Identifier
1124535604
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
2238700C Issued in 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
Last updated
Feb 18, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

32787 US Route 11
Philadelphia, NY 13673

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124535604. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 1, 1965 in NY
Enrollment address
32787 US Route 11
Philadelphia, NY 13673
Related CCNs
331318

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Carthage Area Hosp32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

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 DirectorGoverning Board Vice President May 1, 2010
Morgan Pierce Individual Corporate OfficerVP of Finance Jan 1, 2023
Jerian O'Dell Individual Corporate OfficerCoo 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 DirectorGoverning Board Treasurer May 1, 2016
Kenneth J Fish Individual Corporate Director May 1, 2002
Gary Rowe Individual Corporate DirectorGoverning Board President May 1, 2007
Patti Earl Individual Corporate DirectorBoard Member Jan 1, 2023
Adam Fuller Individual Corporate Director May 1, 2013
Larry Hasseler Individual Corporate DirectorGoverning Board Secretary May 1, 2006
Jennifer Premo Individual Corporate DirectorBoard Member Jan 1, 2023

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1515110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1124535604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST ST",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136199703",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32787 US ROUTE 11",
            "city": "PHILADELPHIA",
            "state": "NY",
            "postal_code": "13673",
            "telephone_number": "315-642-0216",
            "fax_number": "315-654-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE AREA HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-05",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-519-5207"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NY",
            "license": "2238700C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, NY

Sources for this page

Verify at the official NPI Registry.