NPIMap

Organization Active NPI

Dayton Children's Hospital

  • Children's Hospital
  • Miamisburg, OH
National Provider Identifier
1366994584
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
Legal business name
DAYTON CHILDREN'S HOSPITAL
Practice address
3333 West Tech Road
Miamisburg, OH 45342-0817
Phone
(937) 641-3000
Fax
(937) 641-6116
NPI assigned
Nov 4, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Chris Bergman
Title
Chief Financial Officer - Cfo
Phone
(937) 641-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Hospital 282NC2000X Primary

Addresses

Primary practice location

3333 West Tech Road
Miamisburg, OH 45342-0817

Mailing address

1 Childrens PLZ
Dayton, OH 45404-1873
Phone (937) 641-3000

Other identifiers 1

IdentifierTypeStateIssuer
0465509MedicaidOH

Other names 1

  • Dayton Children's Hospital - South Campus Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070508000351 OH Part A Provider - Hospital 5496792418 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, OH; Springfield, OH; Springboro, OH; Miamisburg, OH; Lima, OH; Lebanon, OH; Kettering, OH; Fairborn, OH…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366994584. Details of each certification follow.

Hospital certification: CCN 363306

Legal name
DAYTON CHILDRENS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Jul 1, 1984
Last certification
Aug 16, 2018
Beds
155
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 26, 1963 in OH
Enrollment address
1 Childrens PLZ
Dayton, OH 45404-1815
Other Hospital Practice Location
Hospital subgroups
Acute care, Children’s

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Dayton Childrens HospitalCCN 363306 · All quality measures
Type
Childrens
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Dayton Childrens Hospital11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Michael McQuiston Individual Corporate OfficerVice-Chair (Board) Nov 1, 2017
Cynthia Burger Individual Corporate OfficerVP, Chief Patient Experience Office May 5, 2014
W-2 Managing EmployeeVP, Chief Patient Experience Office May 5, 2014
Operational/Managerial ControlVP, Chief Patient Experience Office May 5, 2014
Angela Kehl Individual W-2 Managing EmployeeManager Pos Operations Payer Enroll May 8, 2022 100%
Jacqueline Y Gamblin Individual Corporate OfficerSecretary/Treasurer (Board) Oct 1, 2021
Linda Black-Kurek Individual Corporate OfficerVice-Chair Nov 1, 2015
Todd Pleiman Individual Corporate OfficerAssist. Secretary/Treasurer (Board) Oct 1, 2018
Peyton Fullenkamp Individual W-2 Managing EmployeePayer Enrollment Team Lead Mar 24, 2024 100%
Adam Gary Mezoff Individual Corporate Officer Mar 18, 2013
W-2 Managing Employee Mar 18, 2013
Operational/Managerial Control Mar 18, 2013
Adele R Johnson-Kebe Individual Corporate OfficerVP, Chief Human Resources Officer Aug 16, 2022
W-2 Managing EmployeeVP, Chief Human Resources Officer Aug 16, 2022
Operational/Managerial ControlVP, Chief Human Resources Officer Aug 16, 2022
Chris E Bergman Individual Corporate OfficerVP, Chief Financial Officer Jan 4, 2016
W-2 Managing EmployeeVP, Chief Financial Officer Jan 4, 2016
Operational/Managerial ControlVP, Chief Financial Officer Jan 1, 2016
Kelly H Kavanaugh Individual Corporate OfficerVP, Chief Strategy Officer Dec 28, 2014
W-2 Managing EmployeeVP, Chief Strategy Officer Dec 28, 2014
Operational/Managerial ControlVP, Chief Strategy Officer Dec 28, 2014
Jennifer Yates Individual Corporate DirectorDirector- Revenue Cycle-Ins Billing Oct 1, 2018
W-2 Managing EmployeeDirector- Revenue Cycle-Ins Billing Oct 1, 2018
Operational/Managerial ControlDirector- Revenue Cycle-Ins Billing Oct 1, 2018
Gregory Cook Dillard Individual Corporate DirectorExecutive Director, Revenue Cycle Jan 3, 2017
W-2 Managing EmployeeExecutive Director- Revenue Cycle Jan 3, 2017
Operational/Managerial ControlExecutive Director, Revenue Cycle Jan 3, 2017
Deborah Feldman Individual Corporate OfficerPresident, Chief Executive Officer Jul 1, 2012
W-2 Managing EmployeePresident, Chief Executive Officer Jul 1, 2012
Operational/Managerial ControlPresident, Chief Executive Officer Jul 1, 2012
Charles Kidwell Individual Corporate OfficerVP, Chief Legal Officer Mar 18, 2013
W-2 Managing EmployeeVP, Chief Legal Officer Mar 18, 2013
Operational/Managerial ControlVP, Chief Legal Officer Mar 18, 2013
John C Duby Individual Corporate OfficerVP, Chair Dept of Pediatrics Oct 1, 2015
Operational/Managerial ControlVP, Chair, Dept of Pediatrics Oct 1, 2015
James D Whalen Individual Corporate OfficerChairperson (Board) Nov 1, 2016
Jayne Gmeiner Individual Corporate OfficerVP, Chief Nursing Officer Jul 27, 2015
W-2 Managing EmployeeVP, Chief Nursing Officer Jul 27, 2015
Operational/Managerial ControlVP, Chief Nursing Officer Jul 27, 2015
Benjamin R Goodstein Individual Corporate OfficerVP, Chief Ambulatory Officer Jan 6, 2014
W-2 Managing EmployeeVP, Chief Ambulatory Officer Jan 6, 2014
Operational/Managerial ControlVP, Chief Ambulatory Officer Jan 6, 2014

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1366994584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041873",
            "telephone_number": "937-641-3000",
            "fax_number": "937-641-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 WEST TECH ROAD",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453420817",
            "telephone_number": "937-641-3000",
            "fax_number": "937-641-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYTON CHILDREN'S HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BERGMAN",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER - CFO",
        "authorized_official_telephone_number": "937-641-3338",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0465509",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dayton Children's Hospital - South Campus",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Miamisburg, OH

Sources for this page

Verify at the official NPI Registry.