NPIMap

Organization Active NPI

County of Medina Auditor

  • Federally Qualified Health Center (FQHC)
  • Medina, OH
National Provider Identifier
1154800340
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF MEDINA AUDITOR
Practice address
4800 Ledgewood Drive
Health Center
Medina, OH 44256-7666
Phone
(330) 723-9688
Fax
(330) 723-9659
NPI assigned
Aug 9, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Authorized official

Name
Krista Wasowski
Title
Health Commissioner
Phone
(330) 723-9688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4800 Ledgewood Drive
Health Center
Medina, OH 44256-7666

Mailing address

4800 Ledgewood Drive
Health Center
Medina, OH 44256-7666
Phone (330) 723-9688

Other names 1

  • Medina County Health Department Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181029000357 OH Part A Provider - Federally Qualified Health Center (FQHC) 6709981764 Practice locations: Medina, OH

Federally qualified health center certification: CCN 361189

Legal name
COUNTY OF MEDINA AUDITOR
Doing business as
MEDINA COUNTY HEALTH DEPARTMENT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2018
Last certification
Oct 17, 2018
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
4800 Ledgewood Dr
Medina, OH 44256-7666

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
County of Medina Auditor5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
William Supeck Individual Corporate OfficerPresident Aug 1, 2018
Operational/Managerial ControlPresident Aug 1, 2018
Debbie Kubena-Yatsko Individual W-2 Managing EmployeeExecutive Director Oct 26, 2021
Operational/Managerial ControlExecutive Director Oct 26, 2021
Krista Wasowski Individual W-2 Managing EmployeeHealth Commissioner Aug 1, 2018
Operational/Managerial ControlHealth Commissioner Jul 1, 2012
County of Medina Auditor Organization, Medina, OH Operational/Managerial Control Jul 1, 2012

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Medina County Health DepartmentWadsworth, OH, CCN 721849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 7, 2020
Jan 7, 2020

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1154800340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 LEDGEWOOD DRIVE",
            "address_2": "HEALTH CENTER",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442567666",
            "telephone_number": "330-723-9688",
            "fax_number": "330-723-9659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 LEDGEWOOD DRIVE",
            "address_2": "HEALTH CENTER",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442567666",
            "telephone_number": "330-723-9688",
            "fax_number": "330-723-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF MEDINA AUDITOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "WASOWSKI",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "HEALTH COMMISSIONER",
        "authorized_official_telephone_number": "330-723-9688"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medina County Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.