NPIMap

Organization Active NPI

Marietta Memorial Hospital of Tyler County Inc

  • Community Based Hospice Care Agency
  • Sistersville, WV
National Provider Identifier
1245839802
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Practice address
314 S Wells St
Sistersville, WV 26175-1098
Phone
(304) 652-2611
Fax
(304) 652-1448
NPI assigned
Oct 23, 2020
Organization subpart
Yes
Parent organization
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Authorized official

Name
Paul Westbrock
Title
VP, Legal Affairs
Phone
(740) 374-1581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

314 S Wells St
Sistersville, WV 26175-1098

Mailing address

C/O Paul Westborck
314 S Wells St
Sistersville, WV 26175-1098
Phone (304) 652-2611

Other names 1

  • Journey Hospice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201211002790 WV Part A Provider - Hospice 4385055342 Practice locations: Sistersville, WV
O20210601001753 WV Part B Supplier - Clinic/Group Practice 4385055342 Receives reassigned benefits from 45 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Middlebourne, WV; Saint Marys, WV; Sistersville, WV; Williamstown, WV

Hospice certification: CCN 511510

Legal name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Doing business as
JOURNEY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 9, 1991
Last certification
Sep 1, 2020
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 2020 in WV
Enrollment address
314 S Wells St
Sistersville, WV 26175-1098

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Journey HospiceCCN 511510
Ownership
Government
Certified
May 9, 1991
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Marietta Memorial Hospital of Tyler County Inc6 organizations share this tax ID, including this one
Part of
Marietta Memorial Hospital of Tyler County Inc

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
James Barengo Individual Corporate DirectorBoard of Director Oct 1, 2020
Garrett Karr Individual Corporate DirectorBoard of Directors Jan 1, 2026
Sheryl Holdren Individual Corporate DirectorBoard of Director Oct 1, 2020
Terry E Rataiczak Individual Corporate DirectorBoard of Director Oct 1, 2020
Carol a Schneeberger Individual Corporate DirectorBoard of Directors Jan 1, 2020
Michael Iaderosa Individual Corporate DirectorBoard of Director Oct 1, 2020
Joseph a Zacharias Individual W-2 Managing EmployeeMD; Feb 13, 2025
Joseph D Cooper Individual Corporate DirectorBoard of Director Oct 1, 2020
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Coordinator Oct 1, 2020
Paul G Westbrock Individual W-2 Managing EmployeeCompliance Officer Oct 1, 2020
Colleen Cook Individual Corporate DirectorBoard of Director Oct 1, 2020
Elizabeth a Helmick Individual Corporate DirectorTreasurer Feb 1, 2021
Christopher Alexander Cockerham Individual Corporate DirectorBoard of Directors Jan 1, 2020
Thomas Danford Individual Corporate DirectorSecretary Oct 1, 2020
Matthew Pottmeyer Individual Corporate DirectorBoard of Directors Jan 1, 2024
Heather Kincaid Individual Corporate DirectorBoard of Directors Jan 1, 2025
Michael Archer Individual Corporate DirectorPast Chairperson Oct 1, 2020
Gregg M Emerick Individual Corporate DirectorVice Chairperson Oct 1, 2020
Douglas Full Individual Corporate OfficerCfo Jan 1, 2024
Stephen C Keiser Individual Corporate DirectorChairperson Oct 1, 2020

Owners & managing parties with NPI records 3

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
Sistersville General Hospital Swing Bed UnitSistersville, WV, CCN 51Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

Owned or controlled facilities with NPI records 1

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

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2020 Change of OwnershipThis provider was the buyer Journey HospiceCCN 511510, WV, NPI 1659475812

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1245839802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "C/O PAUL WESTBORCK",
            "address_2": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-652-2611",
            "fax_number": "304-652-1448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-652-2611",
            "fax_number": "304-652-1448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "WESTBROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "VP, LEGAL AFFAIRS",
        "authorized_official_telephone_number": "740-374-1581"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Journey Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sistersville, WV

Sources for this page

Verify at the official NPI Registry.