NPIMap

Organization Active NPI

Charleston Medical Center, Inc.

  • General Acute Care Hospital
  • Fayetteville, WV
National Provider Identifier
1174479513
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
CHARLESTON MEDICAL CENTER, INC.
Practice address
211 W Maple Ave
Fayetteville, WV 25840-1445
Phone
(304) 900-5511
NPI assigned
Mar 9, 2026
Last updated
Sep 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

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

Authorized official

Name
Ginger Peters
Title
Payer Enrollment Representative
Phone
(304) 388-0112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

211 W Maple Ave
Fayetteville, WV 25840-1445

Mailing address

211 W Maple Ave
Fayetteville, WV 25840-1413
Phone (304) 900-5511

Other names 1

  • Vandalia Health Multi-Specialty Office Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031223000426 WV Part B Supplier - Clinic/Group Practice 3375441637 Receives reassigned benefits from 1,595 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20071210000438 WV Part A Provider - Hospital 3375441637 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174479513. Details of each certification follow.

Hospital certification: CCN 510022

Legal name
CHARLESTON AREA MEDICAL CENTER INC
Doing business as
VANDALIA HEALTH CHARLESTON AREA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 1, 1972
Last certification
Apr 11, 2014
Beds
908
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1972 in WV
Enrollment address
501 Morris St
Charleston, WV 25301-1326
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

Care Compare: Hospital

Medicare Care Compare
Listed as
Charleston Area Medical CenterCCN 510022 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Dane E Beavers MD72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
John R Hoblitzell Individual Corporate DirectorMember Board of Trustees Apr 28, 2004
Melvin Jones Individual Corporate DirectorMember of Board of Trustees Jan 1, 2016
Ken Tackett Individual Corporate DirectorMember Board of Trustees Jan 1, 2012
Edwin Welch Individual Corporate DirectorMember Board of Trustees Jan 1, 1993
Fonda Elliot Individual Corporate DirectorMember Board of Trustees Jan 1, 2012
Glenn Crotty Individual Corporate DirectorChief Operating Officer Mar 28, 2004
W-2 Managing Employee Mar 28, 2004
David L Ramsey Individual 5% Or Greater Indirect Ownership InterestPresident and Ceo Sep 1, 2000 40%
Corporate OfficerPresident and Ceo Sep 1, 2000
Corporate DirectorPresident and Ceo Sep 1, 2000
W-2 Managing Employee Sep 1, 2000
Operational/Managerial ControlPresident and Ceo Sep 1, 2000
Mark a Chandler Individual Corporate DirectorMember Board of Trustees Jan 24, 2007
Chad Hovis Individual W-2 Managing EmployeeVP of Finance Sep 1, 2022
James Robert Campbell Individual Corporate DirectorChief of Staff Jan 1, 2023
Vandalia Health Inc Organization, Charleston, WV Corporation, Medical provider/supplier, Medical staffing company, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2022 100%
Operational/Managerial Control Sep 1, 2022 100%
Jeffrey D Sandene Individual Corporate DirectorExecutive VP and Cfo Dec 1, 2023
W-2 Managing EmployeeExecutive VP and Cfo Dec 1, 2023
Charles Capito Individual Corporate DirectorMember Board of Trustees Jan 1, 2011
Karen Price Individual Corporate DirectorMember Board of Trustees Feb 25, 2009
Stefan R Maxwell Individual Corporate DirectorMember Board of Trustees Jan 1, 2021
Eric a Hicks Individual Corporate DirectorMember Board of Trustees Jan 1, 2021

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 1,621

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

View all 1,621

NPI Registry JSON

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

{
    "created_epoch": "1773014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789084800000",
    "number": "1174479513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W MAPLE AVE",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401413",
            "telephone_number": "304-900-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W MAPLE AVE",
            "city": "FAYETTEVILLE",
            "state": "WV",
            "postal_code": "258401445",
            "telephone_number": "304-900-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-09",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "GINGER",
        "authorized_official_title_or_position": "PAYER ENROLLMENT REPRESENTATIVE",
        "authorized_official_telephone_number": "304-388-0112"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vandalia Health Multi-Specialty Office",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, WV

Sources for this page

Verify at the official NPI Registry.