NPIMap

Organization Active NPI

Pocahontas Memorial Hospital

Doing business as Pocahontas Memorial Hospital Medical Practice RHC

  • Rural Health Clinic/Center
  • Buckeye, WV
National Provider Identifier
1346523206
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
16 Issued in WV
Legal business name
POCAHONTAS MEMORIAL HOSPITAL
Doing business as
Pocahontas Memorial Hospital Medical Practice RHC
Practice address
150 Duncan Rd
Buckeye, WV 24924
Phone
(304) 799-6200
Fax
(304) 799-6636
NPI assigned
Sep 27, 2011
Last updated
Feb 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Authorized official

Name
Shannon Ruth Starcher
Title
Provider Enrollment
Phone
(304) 799-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 16 WV Primary

Addresses

Primary practice location

150 Duncan Rd
Buckeye, WV 24924

Mailing address

150 Duncan Rd
Buckeye, WV 24924
Phone (304) 799-6200

Other identifiers 1

IdentifierTypeStateIssuer
3810023879MedicaidWV

Other names 1

  • Pocahontas Memorial Hospital Medical Practice RHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120130000489 WV Part A Provider - Rural Health Clinic 9234100645 Practice locations: Buckeye, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346523206. Details of each certification follow.

Rural health clinic certification: CCN 513415

Legal name
POCAHONTAS MEMORIAL HOSPITAL
Doing business as
POCAHONTAS MEMORIAL HOSPITAL MEDICAL PRACTICE RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 14, 2012
Last certification
Oct 11, 2022
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
150 Duncan Rd
Buckeye, WV 24924-9037
Related CCNs
511314

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).

National Provider Directory

National Provider Directory
Tax ID family
Pocahontas Memorial Hos9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Thane Ryder Individual Corporate OfficerBoard Member Jan 1, 2025
Shannon R Starcher Individual Corporate OfficerProvider Enrollment Jul 1, 2018
Freda Jackson Individual Corporate Officer Jul 1, 2013
Donald McNeel Individual Corporate Director Jul 1, 2010
Timothy McClung Individual Corporate Officer Sep 1, 2019
Sara Casto Individual W-2 Managing Employee Dec 1, 2011
Wanessa Lynn Cassell Individual W-2 Managing Employee Dec 1, 2009
Chad Carpenter Individual Corporate Officer Sep 30, 2010
Michelle Deeds Individual Operational/Managerial ControlCeo Jul 7, 2023
Jarrell Clifton Individual Corporate Officer Jul 1, 2018
Janet Ghigo Individual Corporate Director Sep 24, 2009
Kelby Lyn Faulkiner Individual Corporate Officer May 1, 2021
Jesse Groseclose Individual Corporate OfficerBoard Member Jun 27, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Pocahontas Memorial HospitalBuckeye, WV, CCN 51Z314 Hospital Operational/Managerial Control Aug 9, 2010
Pocahontas Memorial HospitalBuckeye, WV, CCN 511314 Hospital Operational/Managerial Control Aug 9, 2010

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582156800000",
    "number": "1346523206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DUNCAN RD",
            "city": "BUCKEYE",
            "state": "WV",
            "postal_code": "24924",
            "telephone_number": "304-799-6200",
            "fax_number": "304-799-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 DUNCAN RD",
            "city": "BUCKEYE",
            "state": "WV",
            "postal_code": "24924",
            "telephone_number": "304-799-6200",
            "fax_number": "304-799-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POCAHONTAS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-27",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A",
        "authorized_official_last_name": "STARCHER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "304-799-7400"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WV",
            "license": "16",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810023879",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pocahontas Memorial Hospital Medical Practice RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pocahontas Memorial Hospital Medical Practice RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buckeye, WV

Sources for this page

Verify at the official NPI Registry.