NPIMap

Organization Active NPI

Charles Cole Memorial Hospital

  • Rural Health Clinic/Center
  • Ulysses, PA
National Provider Identifier
1275605776
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHARLES COLE MEMORIAL HOSPITAL
Practice address
511 Academy St
Ulysses, PA 16948-9580
Phone
(814) 848-7555
NPI assigned
Nov 14, 2006
Last updated
Sep 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

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

Authorized official

Name
Daniel James GlunkNPI 1881654010
Title
Interim President
Phone
(570) 321-2284

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

511 Academy St
Ulysses, PA 16948-9580

Mailing address

511 Academy St
Ulysses, PA 16948-9580
Phone (814) 848-7555

Other identifiers 1

IdentifierTypeStateIssuer
100001127-0060MedicaidPA

Other names 1

  • Northern Potter Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080724000737 PA Part A Provider - Rural Health Clinic 3779487475 Practice locations: Ulysses, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275605776. Details of each certification follow.

Rural health clinic certification: CCN 393983

Legal name
CHARLES COLE MEMORIAL HOSPITAL
Doing business as
NORTHERN POTTER HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 15, 1995
Last certification
Nov 30, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1910 in PA
Enrollment address
511 Academy Street
Northern Potter Health Center
Ulysses, PA 16948-9580
Related CCNs
391313

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

Other NPIs with the same Medicare PAC ID 12

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

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
39D0185337Northern Potter Health Center511 Academy Street, Ulysses, PA 16948Certificate of waiverMar 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Charles Cole Mem Hosp L51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Michael Callahan Individual Corporate DirectorBoard Member Oct 1, 2020
Maribeth McLaughlin Individual Corporate DirectorBoard Member Mar 1, 2018
Patricia Devlin Individual Corporate Director Jan 1, 2025
W-2 Managing EmployeeAd; Jan 1, 2025
Patrick Larsen Individual Corporate DirectorBoard Member Oct 1, 2019
Josh Costa Individual Corporate DirectorBoard Member Jan 3, 2022
Carrie Ennis Individual Corporate DirectorBoard Member Mar 1, 2018
Ron Reynolds Individual Corporate OfficerPresident Oct 6, 2025
Corporate DirectorPresident Oct 6, 2025
W-2 Managing EmployeeAd; Oct 6, 2025
Elizabeth Wallace Individual Corporate OfficerSecretary Jan 3, 2022
Melynda Budd Individual Corporate OfficerTreasurer Jan 3, 2022
Alana Huck Individual Corporate OfficerVice Chair Jan 3, 2022
Upmc Organization, Pittsburgh, PA Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Mary Ann Rigas Individual Corporate DirectorBoard Member Oct 1, 2019
David Lopatofsky Individual Corporate DirectorBoard Member Mar 1, 2018
John Leete Individual Corporate OfficerChair Jan 3, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 63

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

View all 63

Practitioners & affiliated clinicians

Practitioners 7

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757376000000",
    "number": "1275605776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 ACADEMY ST",
            "city": "ULYSSES",
            "state": "PA",
            "postal_code": "169489580",
            "telephone_number": "814-848-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 ACADEMY ST",
            "city": "ULYSSES",
            "state": "PA",
            "postal_code": "169489580",
            "telephone_number": "814-848-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES COLE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A",
        "authorized_official_last_name": "GLUNK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "INTERIM PRESIDENT",
        "authorized_official_telephone_number": "570-321-2284"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001127-0060",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Potter Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Northern Potter Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ulysses, PA

Sources for this page

Verify at the official NPI Registry.