NPIMap

Braxton County Memorial Hospital

Organization Active NPI Critical Access Hospital · Gassaway, WV

NPI 1356304547 · NPPES record last updated Oct 4, 2023

Key facts

NPI
1356304547
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
03 (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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Member of 1

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

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

Facilities with the same owner 52

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

View all 52

Practitioners 127

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 127

Affiliated clinicians 132

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

View all 132

Medicare Care Compare: Hospital

Listed as
Braxton County Memorial Hospital, Inc CCN 511308
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WV

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
Corporation · Non-profit
Incorporated
Aug 26, 1996 in WV
Enrollment address
100 Hoylman Drive
Gassaway, WV 26624-9320
Other Hospital Practice Location

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 Director
Board Member		 Jan 1, 2019
Robin Eckhart
Individual 		W-2 Managing Employee
VP Finance		 Feb 10, 2020
Sally Howard
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Deborah Burge
Individual 		W-2 Managing Employee
MGR ENT Patient Fin SVCS		 Jun 1, 2021
Okey Silman
Individual 		W-2 Managing Employee
Director, Revenue Cycle Integration		 Jul 1, 2019
Danielle I Heston-Raddish
Individual 		W-2 Managing Employee
Director, Patient Financial Service		 Jul 1, 2019
Richard Facemire
Individual 		Corporate Director
Board 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 Director
Board Member		 Jul 1, 2007 12.5%
Louis G Roe
Individual 		Corporate Director Jan 1, 2022
W-2 Managing Employee
Ceo		 Dec 12, 2021
Timothy Sodaro
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Stephanie Lea Frame
Individual 		Corporate Officer
Board Member		 Jul 1, 2016
Barbara Adams
Individual 		Corporate Director
Board Member		 Jul 1, 2007 12.5%
Kimberly Knight
Individual 		Corporate Director
Cfo		 Jan 1, 2014 12.5%
W-2 Managing Employee
Cfo		 Jan 1, 2014 12.5%

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 Center
Gassaway, 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

Medicare enrollment records

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

National Provider Directory

Locations

29 Hospital Plz
Ste B
Weston, WV 26452
Phone (304) 269-0030

Specialties & licenses

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

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 4, 2023.

{
    "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

All providers in Gassaway, WV · Critical Access Hospital in West Virginia

Sources for this page

Verify at the official NPI Registry.