NPIMap

Organization Active NPI

Camden on Gauley Medical Center Inc

Doing business as Camden Family Health-Red Oak

  • Federally Qualified Health Center (FQHC)
  • Craigsville, WV
National Provider Identifier
1215394648
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
Camden Family Health-Red Oak
Practice address
46 Red Oak Dr
Craigsville, WV 26205-3102
Phone
(304) 742-5999
NPI assigned
Jan 15, 2016
Last updated
Dec 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Authorized official

Name
Margaret Hickey
Title
Ceo
Phone
(304) 226-5725

Specialties & licenses 1

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

Addresses

Primary practice location

46 Red Oak Dr
Craigsville, WV 26205-3102

Mailing address

46 Red Oak Dr
Craigsville, WV 26205-3102
Phone (304) 742-5999

Other identifiers 1

IdentifierTypeStateIssuer
1215394648-001MedicaidWV

Other names 1

  • Camden Family Health-Red Oak Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160310001831 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 1 other NPI on this enrollment
Practice locations: Craigsville, WV
O20200429000282 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 19 practitioners
Practice locations: Craigsville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215394648. Details of each certification follow.

Federally qualified health center certification: CCN 511091

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2016
Last certification
Jan 26, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 30, 1979 in WV
Enrollment address
46 Red Oak Dr
Craigsville, WV 26205-3102

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Camden on Gauley Medica21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

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
Roy Moose Individual Corporate DirectorBoard Member Jan 1, 2010
Elizabeth Snyder Individual Corporate Director Jan 1, 1997
Barbara Butler Individual Corporate DirectorBoard Member Nov 18, 2019
Brandon Moll Individual Corporate DirectorBoard Member Aug 12, 2022
Sharon Hanna Individual Corporate DirectorBoard Member Jan 1, 1981
Margaret Hickey Individual Corporate OfficerCeo Mar 1, 2011
W-2 Managing EmployeeCeo Mar 1, 2011
Operational/Managerial ControlCeo Mar 1, 2011
Camden on Gauley Medical Center Inc Organization, Camden on Gauley, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 1979 100%
James Gamble Individual Corporate DirectorBoard Member Jan 1, 1989
Melissa Rogers Individual W-2 Managing EmployeeCoo Mar 24, 2014
Tiffany Montgomery Individual Corporate DirectorBoard Member Mar 22, 2021
Jane Sherwood Individual Corporate DirectorBoard Member Aug 1, 2020

Owners & managing parties with NPI records 24

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

View all 24

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Camden on Gauley Medical Center IncSummersville, WV, CCN 511145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Owned or controlled facilities with NPI records 2

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.

Practitioners & affiliated clinicians

Practitioners 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1215394648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 RED OAK DR",
            "city": "CRAIGSVILLE",
            "state": "WV",
            "postal_code": "262053102",
            "telephone_number": "304-742-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 RED OAK DR",
            "city": "CRAIGSVILLE",
            "state": "WV",
            "postal_code": "262053102",
            "telephone_number": "304-742-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215394648-001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Health-Red Oak",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Health-Red Oak",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Craigsville, WV

Sources for this page

Verify at the official NPI Registry.