Orrville Hospital Foundation
Organization Active NPI Rural Health Clinic/Center · Carrollton, OH
NPI 1255970513 · NPPES record last updated Feb 3, 2025
Key facts
- NPI
- 1255970513
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ORRVILLE HOSPITAL FOUNDATION
- Practice address
- 1020 Trump Rd NW Ste 2/4
Carrollton, OH 44615-8422 - Phone
- (330) 627-0884
- Fax
- (330) 627-0885
- NPI assigned
- Jan 3, 2020
- Organization subpart
- No
Authorized official
- Name
- Adam M Luntz
- Title
- Cfo
- Phone
- (330) 363-3889
Owners & managing parties with NPI records 2
-
Andrew J Naumoff, MD
-
Nicholas E Sherock Jr., D.O.
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Facilities with the same owner 14
Practitioners 78
-
Sarah J Atkinson, CNP
-
Kelli J Baker, CNP
-
Jillian Berkshire, NP-C
-
Emily Brown, DO
-
Sarah Elizabeth Ensinger, CRNP
-
Carl R Fry, D.O.
-
Mandal Brian Haas, M.D.
-
Holly L Inman, CRNP
-
Bryan Anthony Lewis, CNP
-
Stephanie J Lovett, CNP
-
Pamela Sue McKee, CNP
-
Melissa Erin Prokop, NURSE PRACTITIONER
-
Sayeda M Akbar, MSN, APRN, FNP-C
-
Mathew Armstrong, MSN FNP-BC
-
Ryan Baltes, APRN
-
Raffi Bardakjian, MD
-
Nicholas R Bellanco, M.D.
-
Katie Mae Brenner, D.O.
-
Brett Buller, D.O.
-
Samantha Clark, MD
-
Lisa M Ditchey, DO
-
Jay Dyer, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Rural health clinic certification: CCN 363426
- Legal name
- ORRVILLE HOSPITAL FOUNDATION
- Doing business as
- AULTMAN ORRVILLE CARROLLTON HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 23, 2020
- Last certification
- Jun 23, 2020
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 26, 1985 in OH
- Enrollment address
- 1020 Trump Rd NW
Ste 2/4
Carrollton, OH 44615-8422 - Related CCNs
- 361323
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Auble |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Thomas S Gregory |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Nicholas Edward Sherock |
Corporate Director |
Jan 1, 2019 | 7.69% |
| Jonathan Basso |
Corporate Officer |
Jun 18, 2018 | 7.69% |
| Becky Jewell |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Jeffrey B Miller |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Douglas Sibila |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Edward Roth |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Aultman Health Foundation |
5% Or Greater Direct Ownership Interest | Dec 20, 2011 | 100% |
| Diane Jarrett |
Corporate Director |
Jan 28, 2016 | 7.69% |
| Jennifer Kessel |
Corporate Officer |
Jun 18, 2018 | 7.69% |
| Corporate Director |
Jun 18, 2018 | ||
| Andrew J Naumoff |
Corporate Officer |
Jan 1, 2014 | 7.69% |
| Adam Luntz |
Corporate Officer |
Apr 1, 2016 | |
| Operational/Managerial Control |
Apr 1, 2016 | ||
| Christopher Remark |
Corporate Director |
Jan 31, 2018 | 7.69% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200213001257 | OH | Part a Provider - Rural Health Clinic | 7911890546 | Practice locations: Carrollton, OH |
National Provider Directory
- Tax ID family
- Orrville Hospital Foundation
Locations
1020 Trump Rd NW
Ste 24
Carrollton, OH 44615
Phone (330) 627-0884
2635 Tusky Valley Rd NE
Zoarville, OH 44656
Phone (330) 859-1205
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1020 Trump Rd NW Ste 2/4
Carrollton, OH 44615-8422
Mailing address
PO Box 80690
Canton, OH 44708-0690
Phone (330) 479-8705
Other names
- Aultman Orrville Carrollton Health Center
Other providers in Carrollton, OH
- Lowell B Myers II
- Kelsea Diane Naylor
- Ocal Solutions
- Kathleen Ruth Okey
- Cynthia Olivito
- Orrville Hospital Foundation
- Pratheep Pawa
- Stacey Pennell
- Richard Percic
- Crystal M Pickens
All providers in Carrollton, OH · Rural Health Clinic/Center in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.