NPIMap

Organization Active NPI

Grafton City Hospital Inc

Doing business as Tygart Valley Total Care Clinic

  • Rural Health Clinic/Center
  • Grafton, WV
National Provider Identifier
1336200344
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
14 Issued in WV
Legal business name
GRAFTON CITY HOSPITAL INC
Doing business as
Tygart Valley Total Care Clinic
Practice address
500 Market St
Grafton, WV 26354-1184
Phone
(304) 265-0400
Fax
(304) 265-6417
NPI assigned
Dec 13, 2006
Last updated
Aug 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Authorized official

Name
Jeffrey E Lilley
Title
Administrator
Phone
(304) 265-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 14 WV Primary

Addresses

Primary practice location

500 Market St
Grafton, WV 26354-1184

Mailing address

500 Market St
Grafton, WV 26354-1184
Phone (304) 265-0400

Other identifiers 1

IdentifierTypeStateIssuer
0034632000MedicaidWV

Other names 1

  • TYGART VALLEY TOTAL CARE CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040513000160 WV Part B Supplier - Clinic/Group Practice 7719897263 Receives reassigned benefits from 49 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grafton, WV
O20101022000607 WV Part A Provider - Rural Health Clinic 7719897263 Practice locations: Grafton, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336200344. Details of each certification follow.

Rural health clinic certification: CCN 513978

Legal name
GRAFTON CITY HOSPITAL INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 18, 1994
Last certification
Dec 9, 2024
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1915 in WV
Enrollment address
1 Hospital Plaza
Grafton, WV 26354-1184
Related CCNs
511307

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).

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

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Kevin M Gessler Individual Operational/Managerial Control Nov 1, 2021

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Grafton City Hospital, Inc.Grafton, WV, CCN 51Z307 Hospital Operational/Managerial Control Feb 23, 2015

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1336200344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MARKET ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541184",
            "telephone_number": "304-265-0400",
            "fax_number": "304-265-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MARKET ST",
            "city": "GRAFTON",
            "state": "WV",
            "postal_code": "263541184",
            "telephone_number": "304-265-0400",
            "fax_number": "304-265-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAFTON CITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "LILLEY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "304-265-0400"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WV",
            "license": "14",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0034632000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TYGART VALLEY TOTAL CARE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grafton, WV

Sources for this page

Verify at the official NPI Registry.