NPIMap

Organization Active NPI

Shelby County Memorial Hospital Association Inc.

  • Community Based Hospice Care Agency
  • Sidney, OH
National Provider Identifier
1376531533
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0037HSP Issued in OH
Legal business name
SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC.
Practice address
1083 Fairington Dr
Sidney, OH 45365-8130
Phone
(937) 498-5495
Fax
(937) 498-4669
NPI assigned
Oct 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Alexander Pohlman
Title
Ceo
Phone
(937) 498-5405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0037HSP OH Primary

Addresses

Primary practice location

1083 Fairington Dr
Sidney, OH 45365-8130

Mailing address

915 Michigan St
Sidney, OH 45365-2401
Phone (937) 498-5495

Other names 1

  • WILSON MEMORIAL HOSPITAL Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110330000235 OH Part A Provider - Hospice 0042200248 Practice locations: Sidney, OH

Hospice certification: CCN 361523

Legal name
SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC.
Doing business as
WILSON HEALTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 28, 1987
Last certification
May 27, 2021
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Sep 24, 1920 in OH
Enrollment address
1083 Fairington Dr
Sidney, OH 45365-8130

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: Hospice

Medicare Care Compare
Listed as
Wilson Hospice CareCCN 361523
Ownership
Non-Profit
Certified
Dec 28, 1987
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Wilson Health Home Care5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

1083 Fairington Dr
Sidney, OH 45365
Phone (937) 498-2311

1081 Fairington Dr
Sidney, OH 45365
Phone (937) 493-0009

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Shelly Ann Gasson Individual Corporate Director Apr 1, 2021
Eric John Prenger Individual Corporate DirectorBoard Member Apr 1, 2016
Kenneth F Bosslet Individual W-2 Managing EmployeeMD; Jan 1, 2023
Marian Spicer Individual Corporate Director Apr 1, 2019
Julie a Covault Individual Corporate OfficerCfo May 21, 2012
W-2 Managing EmployeeCfo May 21, 2012
Thomas P Milligan Individual Corporate OfficerSecretary Apr 1, 2023
Nicholas Straka Individual Corporate Director Apr 1, 2023
Mark D. Klosterman Individual W-2 Managing EmployeeAd; Jan 1, 2019
Ralph F Keister Individual Corporate DirectorBoard Member Apr 1, 2024
Jackie Davis Individual Corporate Director Apr 1, 2022
Paul Dentinger Individual Corporate DirectorBoard Member Apr 1, 2020
Gary Heitmeyer Individual Corporate DirectorBoard Member Apr 1, 2022
Jason L Stiver Individual Corporate DirectorBoard Member Apr 1, 2017
Joann Scott Individual W-2 Managing EmployeeDirector of Home Health and Hospice Dec 20, 2004
John Deeds Individual Corporate DirectorBoard Member Apr 1, 2016
Charles J Edelen Individual Corporate DirectorBoard Member Apr 1, 2016
Janice Benanzer Individual Corporate OfficerChair Apr 1, 2023

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 8

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

NPI Registry JSON

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

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1376531533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 MICHIGAN ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453652401",
            "telephone_number": "937-498-5495",
            "fax_number": "937-498-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1083 FAIRINGTON DR",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453658130",
            "telephone_number": "937-498-5495",
            "fax_number": "937-498-4669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY COUNTY MEMORIAL HOSPITAL ASSOCIATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "POHLMAN",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-498-5405"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0037HSP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILSON MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sidney, OH

Sources for this page

Verify at the official NPI Registry.