NPIMap

Organization Active NPI

Cameron Memorial Community Hospital, Inc

  • Home Health Agency
  • Angola, IN
National Provider Identifier
1174526289
Registry record updated Jun 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
05-005308-1 Issued in IN
Legal business name
CAMERON MEMORIAL COMMUNITY HOSPITAL, INC
Practice address
416 E Maumee St
Angola, IN 46703-2015
Phone
(260) 665-2141
Fax
(260) 665-8608
NPI assigned
May 23, 2005
Last updated
Jun 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
CAMERON MEMORIAL COMMUNITY HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2016

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

Authorized official

Name
Douglas Bomba
Title
Cfo
Phone
(260) 665-2141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 05-005308-1 IN Primary

Addresses

Primary practice location

416 E Maumee St
Angola, IN 46703-2015

Mailing address

416 E Maumee St
Angola, IN 46703-2015
Phone (260) 665-2141

Other identifiers 4

IdentifierTypeStateIssuer
000000097654OtherINBLUE CROSS BLUE SHIELD PI
1174526289OtherINPECOS
100263930AMedicaidIN
200056150AMedicaidIN

Other names 1

  • Cameron Home Health Care and Hospice Other name

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
15D0034973Cameron Health416 E Maumee Street, Angola, IN 46703ComplianceApr 11, 2027

National Provider Directory

National Provider Directory
Part of
Cameron Memorial Community Hospital Inc

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1174526289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E MAUMEE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467032015",
            "telephone_number": "260-665-2141",
            "fax_number": "260-665-8608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E MAUMEE ST",
            "city": "ANGOLA",
            "state": "IN",
            "postal_code": "467032015",
            "telephone_number": "260-665-2141",
            "fax_number": "260-665-8608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMERON MEMORIAL COMMUNITY HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMERON MEMORIAL COMMUNITY HOSPITAL, INC",
        "enumeration_date": "2005-05-23",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "BOMBA",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "260-665-2141"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": "05-005308-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PI",
            "identifier": "000000097654",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PECOS",
            "identifier": "1174526289",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100263930A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200056150A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cameron Home Health Care and Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Angola, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.