NPIMap

Organization Active NPI

Greene Memorial Hospital Inc

Doing business as Kettering Health Greene Memorial

  • General Acute Care Hospital
  • Xenia, OH
National Provider Identifier
1255317848
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
1180 Issued in OH
Legal business name
GREENE MEMORIAL HOSPITAL INC
Doing business as
Kettering Health Greene Memorial
Practice address
1141 N Monroe Dr
Xenia, OH 45385-1619
Phone
(937) 352-2000
Fax
(937) 352-3260
NPI assigned
Dec 16, 2005
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Timothy Ko
Title
Kettering Health Cfo
Phone
(937) 395-8522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 1180 OH Primary

Addresses

Primary practice location

1141 N Monroe Dr
Xenia, OH 45385-1619

Mailing address

2110 Leiter Rd
Miamisburg, OH 45342-3598
Phone (937) 914-7601

Other identifiers 2

IdentifierTypeStateIssuer
3409501MedicaidOH
0519648MedicaidOH

Other names 1

  • Kettering Health Greene Memorial Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060912000628 OH Part A Provider - Hospital 3971406539 Practice locations: Beavercreek, OH; Jamestown, OH; Xenia, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255317848. Details of each certification follow.

Hospital certification: CCN 360026

Legal name
GREENE MEMORIAL HOSPITAL INC
Doing business as
KETTERING HEALTH GREENE MEMORIAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 22, 2014
Beds
41
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1971 in OH
Enrollment address
1141 N Monroe Dr
Xenia, OH 45385-1619
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Kettering Health Greene MemorialCCN 360026 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
36D0656390Kettering Health Greene Memorial1141 N Monroe Dr, Xenia, OH 45385AccreditationDec 11, 2027
36D2125621Kettering Health Greene Memorial1141 N Monroe Drive, Xenia, OH 45385Certificate of waiverFeb 9, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Kevin L Sharrett Individual Corporate DirectorBoard Member Jan 31, 2024
Paul Hoover Individual W-2 Managing Employee Sep 29, 2025
Michael Gentry Individual Corporate OfficerKettering Health Ceo Jul 3, 2023
Corporate DirectorBoard Member Jan 31, 2024
Marcellus Robinson Individual Corporate OfficerBoard Chair Apr 30, 2024
Corporate DirectorBoard Member Apr 30, 2024
Keisha Stubbs-Bone Individual Corporate DirectorBoard Member Jan 31, 2024
Vanessa Oliver-Ward Individual Corporate DirectorBoard Member Feb 5, 2025
Tamara L Thomas Individual Corporate DirectorBoard Member Jan 31, 2024
Robert Weigel Individual Corporate DirectorBoard Member Jan 31, 2024
Adele Riley Individual Corporate DirectorBoard Member Jan 31, 2024
Leslie Neff Individual Corporate DirectorBoard Member Jan 31, 2024
John Sackett Individual Corporate DirectorBoard Member Nov 11, 2024
Troy Alan Tyner Individual Corporate DirectorBoard Member Jan 31, 2024
Harvey Sung Ha Hahn Individual Corporate DirectorBoard Member Feb 5, 2025
Timothy Y Ko Individual Corporate OfficerKettering Health Cfo Nov 18, 2022
Andrew Sutton Individual Corporate DirectorBoard Member Feb 5, 2025
Kettering Adventist Healthcare Organization, Miamisburg, OH Corporation, Non-profit Operational/Managerial Control Jul 31, 2009 100%
Other Jan 31, 2024
Cherish J Prutzman Individual Corporate DirectorBoard Member Jan 31, 2024
Robert Patterson Individual Corporate DirectorBoard Member Jan 31, 2024
Peter N Landless Individual Corporate DirectorBoard Member Feb 5, 2025

Owners & managing parties with NPI records 5

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

Facilities with the same owner 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 24

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 24

Affiliated clinicians 259

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

View all 259

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1255317848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 LEITER RD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453423598",
            "telephone_number": "937-914-7601",
            "fax_number": "937-522-7685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 N MONROE DR",
            "city": "XENIA",
            "state": "OH",
            "postal_code": "453851619",
            "telephone_number": "937-352-2000",
            "fax_number": "937-352-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENE MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "KETTERING HEALTH CFO",
        "authorized_official_telephone_number": "937-395-8522"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OH",
            "license": "1180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409501",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0519648",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kettering Health Greene Memorial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Xenia, OH

Sources for this page

Verify at the official NPI Registry.