NPIMap

Organization Active NPI

Keystone Rural Health Consortia, Inc

Doing business as Ridgway Medical Center

  • Federally Qualified Health Center (FQHC)
  • Ridgway, PA
National Provider Identifier
1194260943
Registry record updated Jan 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KEYSTONE RURAL HEALTH CONSORTIA, INC
Doing business as
Ridgway Medical Center
Practice address
49 Ridgmont Dr Ste 1
Ridgway, PA 15853-9700
Phone
(814) 245-2119
Fax
(814) 245-2122
NPI assigned
Jan 4, 2017
Last updated
Jan 2, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2020

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

Authorized official

Name
Kristie Bennardi, CEO
Title
Ceo
Phone
(814) 486-1115

Specialties & licenses 1

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

Addresses

Primary practice location

49 Ridgmont Dr Ste 1
Ridgway, PA 15853-9700

Mailing address

90 E 2ND St
P.O. Box 270
Emporium, PA 15834-1302
Phone (814) 486-1115

Other names 1

  • Ridgway Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050412000691 PA Part B Supplier - Clinic/Group Practice 8022055078 Receives reassigned benefits from 11 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Emporium, PA; Kane, PA; Ridgway, PA
O20170419000793 PA Part A Provider - Federally Qualified Health Center (FQHC) 8022055078 Practice locations: Ridgway, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194260943. Details of each certification follow.

Federally qualified health center certification: CCN 391092

Legal name
KEYSTONE RURAL HEALTH CONSORTIA, INC.
Doing business as
RIDGWAY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 18, 2017
Last certification
Apr 18, 2017
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Feb 7, 1976 in PA
Enrollment address
49 Ridgmont Dr
Ste 1
Ridgway, PA 15853-9700

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

90 E 2nd St
Emporium, PA 15834
Phone (814) 486-0909

118 N Fraley St
Kane, PA 16735
Phone (814) 837-6313

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Sharon Wykoff Individual Operational/Managerial ControlBilling Manager Mar 14, 2017
Dennis Neal Individual Corporate Director Apr 1, 2015
Danielle Reed Individual Operational/Managerial ControlFinancial Controller Mar 14, 2017
John Sidelinger Individual Corporate Director Nov 1, 2011
Linda Slyder Individual Corporate Director Mar 14, 2017
Alan Benson Individual Corporate Director Jun 1, 2017
Tonia Hartzell Individual Corporate Director Jun 1, 2017
James Chorney Individual Corporate Director Aug 16, 2023
Kristie Lenze Individual 5% Or Greater Direct Ownership InterestCeo May 23, 2013
Operational/Managerial ControlCeo Aug 23, 2013
Derrick Goode Individual Corporate Director Jan 5, 2018
Angela Cunningham Individual Corporate Director Feb 16, 2023

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1483488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577923200000",
    "number": "1194260943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 E 2ND ST",
            "address_2": "P.O. BOX 270",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158341302",
            "telephone_number": "814-486-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 RIDGMONT DR STE 1",
            "city": "RIDGWAY",
            "state": "PA",
            "postal_code": "158539700",
            "telephone_number": "814-245-2119",
            "fax_number": "814-245-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE RURAL HEALTH CONSORTIA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-04",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A",
        "authorized_official_last_name": "BENNARDI",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-486-1115",
        "authorized_official_credential": "CEO"
    },
    "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": "Ridgway Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ridgway Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ridgway, PA

Sources for this page

Verify at the official NPI Registry.