NPIMap

Organization Active NPI

Boone Memorial Hospital, Inc

Doing business as BMH Danville Clinic

  • Rural Health Clinic/Center
  • Danville, WV
National Provider Identifier
1124617535
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BOONE MEMORIAL HOSPITAL, INC
Doing business as
BMH Danville Clinic
BMH Walk-In Clinic
Practice address
300 4TH Street
Danville, WV 25053
Phone
(304) 369-8839
NPI assigned
Jan 12, 2021
Last updated
Oct 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BOONE MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Authorized official

Name
Virgil Underwood
Title
Ceo
Phone
(304) 369-1230

Specialties & licenses 1

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

Addresses

Primary practice location

300 4TH Street
Danville, WV 25053

Mailing address

701 Madison Ave
Madison, WV 25130-1699
Phone (304) 369-2932

Other practice location 1

173 State St
Madison, WV 25130-1139
Phone (304) 369-1230 ext. 6602

Other names 2

  • BMH Danville Clinic Doing business as
  • BMH Walk-In Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230512002033 WV Part A Provider - Rural Health Clinic 3375433352 Practice locations: Madison, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124617535. Details of each certification follow.

Rural health clinic certification: CCN 513432

Legal name
BOONE MEMORIAL HOSPITAL INC
Doing business as
BMH WALK-IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 2, 2023
Last certification
May 2, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 2010 in WV
Enrollment address
173 State St
Madison, WV 25130-1139
Related CCNs
511313

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

Other NPIs with the same Medicare PAC ID 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D2174513Danville Clinic, the300 4TH St, Danville, WV 25053Provider-performed microscopyNov 3, 2027
51D2188180Danville Clinic, the300 4TH St, Danville, WV 25053Certificate of waiverJul 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boone Memorial Hospital Home Care HMKR11 organizations share this tax ID, including this one
Part of
Boone Memorial Hospital Home Care HMKR

Other organizations with this tax ID 10

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/boonemh-81155461

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Angela Christian Individual Corporate DirectorCoo Mar 1, 2023
W-2 Managing EmployeeCoo Mar 1, 2023
Douglas Cole Malcolm Individual Corporate DirectorCfo Mar 1, 2023
W-2 Managing EmployeeCfo Mar 1, 2023
Virgil L Underwood Individual Corporate DirectorCeo Mar 1, 2023
W-2 Managing EmployeeCeo Mar 1, 2023

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boone Memorial Hospital IncMadison, WV, CCN 511313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
Boone Memorial HospitalMadison, WV, CCN 51Z313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Family Medical CenterMadison, WV, CCN 513992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Medical ClinicMadison, WV, CCN 513411 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Comfort ClinicComfort, WV, CCN 513433 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 25, 2022
Aug 28, 2022

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698019200000",
    "number": "1124617535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301699",
            "telephone_number": "304-369-2932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 4TH STREET",
            "city": "DANVILLE",
            "state": "WV",
            "postal_code": "25053",
            "telephone_number": "304-369-8839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "173 State St",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WV",
            "postal_code": "251301139",
            "country_code": "US",
            "telephone_number": "304-369-1230 x6602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOONE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOONE MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2021-01-12",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-369-1230"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMH Danville Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BMH Danville Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BMH Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Danville, WV

Sources for this page

Verify at the official NPI Registry.