NPIMap

Organization Active NPI

Braxton County Memorial Hospital

  • Critical Access Hospital
  • Gassaway, WV
National Provider Identifier
1356304547
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
03 Issued in WV
Legal business name
BRAXTON COUNTY MEMORIAL HOSPITAL
Practice address
100 Hoylman Dr
Gassaway, WV 26624-9321
Phone
(304) 364-5156
Fax
(304) 364-5809
NPI assigned
Apr 10, 2006
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Kimberly Dawn Knight
Title
Cfo
Phone
(304) 364-5156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 03 WV Primary

Addresses

Primary practice location

100 Hoylman Dr
Gassaway, WV 26624-9321

Mailing address

100 Hoylman Dr
Gassaway, WV 26624-9321
Phone (304) 364-5156

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com Other
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040401001560 WV Part B Supplier - Clinic/Group Practice 5193717759 Receives reassigned benefits from 117 practitioners
Practice locations: Gassaway, WV
O20070427000449 WV Part A Provider - Critical Access Hospital 5193717759 Receives reassigned benefits from 96 practitioners
Practice locations: Gassaway, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356304547. Details of each certification follow.

Hospital certification: CCN 511308

Legal name
BRAXTON COUNTY MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2000
Last certification
Dec 11, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 26, 1996 in WV
Enrollment address
100 Hoylman Drive
Gassaway, WV 26624-9320
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Braxton County Memorial Hospital, IncCCN 511308 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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 C. Tillman Individual Corporate DirectorBoard Member Jan 1, 2019
Robin Eckhart Individual W-2 Managing EmployeeVP Finance Feb 10, 2020
Sally Howard Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Deborah Burge Individual W-2 Managing EmployeeMGR ENT Patient Fin SVCS Jun 1, 2021
Okey Silman Individual W-2 Managing EmployeeDirector, Revenue Cycle Integration Jul 1, 2019
Danielle I Heston-Raddish Individual W-2 Managing EmployeeDirector, Patient Financial Service Jul 1, 2019
Richard Facemire Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
West Virginia United Health System, Inc Organization, Morgantown, WV Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Lawrence Boggs Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Louis G Roe Individual Corporate Director Jan 1, 2022
W-2 Managing EmployeeCeo Dec 12, 2021
Timothy Sodaro Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Stephanie Lea Frame Individual Corporate OfficerBoard Member Jul 1, 2016
Barbara Adams Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Kimberly Knight Individual Corporate DirectorCfo Jan 1, 2014 12.5%
W-2 Managing EmployeeCfo Jan 1, 2014 12.5%

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 1

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

FacilityTypeRoleSince
Braxton Community Health CenterGassaway, WV, CCN 513400 Rural health clinic 5% Or Greater Direct Ownership Interest (43%)
5% Or Greater Security Interest (57%)		 Jul 7, 2007
Jul 1, 2007

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 125

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 125

Affiliated clinicians 132

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

View all 132

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1356304547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOYLMAN DR",
            "city": "GASSAWAY",
            "state": "WV",
            "postal_code": "266249321",
            "telephone_number": "304-364-5156",
            "fax_number": "304-364-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOYLMAN DR",
            "city": "GASSAWAY",
            "state": "WV",
            "postal_code": "266249321",
            "telephone_number": "304-364-5156",
            "fax_number": "304-364-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAXTON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-364-5156"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WV",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Parkway",
            "address_2": "Suite 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "21044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gassaway, WV

Sources for this page

Verify at the official NPI Registry.