NPIMap

Organization Active NPI

Selby General Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Marietta, OH
National Provider Identifier
1386699197
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
SELBY GENERAL HOSPITAL
Practice address
1106 Colegate Dr
Marietta, OH 45750-1323
Phone
(740) 568-2040
Fax
(740) 568-2089
NPI assigned
May 23, 2006
Last updated
Jan 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SELBY GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Paige Smith
Title
President
Phone
(740) 568-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

1106 Colegate Dr
Marietta, OH 45750-1323

Mailing address

1106 Colegate Dr
Marietta, OH 45750-1323
Phone (740) 568-2048

Other identifiers 2

IdentifierTypeStateIssuer
7943257MedicaidOH
0001482000MedicaidWV

Other names 1

  • Swing Bed Unit Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hospital.provider@mmhs.medicity.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081118000098 OH Part A Provider - Critical Access Hospital 9638087893 Practice locations: Marietta, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386699197. Details of each certification follow.

Hospital certification: CCN 36Z319

Legal name
SELBY GENERAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 12, 1939 in OH
Enrollment address
1106 Colegate Dr
Marietta, OH 45750-1323
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Selby General Hospital Inc7 organizations share this tax ID, including this one
Part of
Selby General Hospital Inc

Other organizations with this tax ID 6

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

Member organizations 1

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
James Barengo Individual Corporate DirectorTreasurer Board of Directors Jan 1, 2014
Sheryl Holdren Individual Corporate DirectorBoard of Directors Jan 1, 2017
Terry E Rataiczak Individual Corporate DirectorBoard of Directors Jan 1, 2019
Carol a Schneeberger Individual Corporate DirectorBoard of Directors Jan 1, 2020
Michael Iaderosa Individual Corporate DirectorBoard of Directors Jun 2, 2008
Joseph D Cooper Individual Corporate DirectorBoard of Directors Jun 2, 2008
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Coordinator Jun 1, 2011
Paul G Westbrock Individual Corporate OfficerCorporate Compliance Officer Jun 19, 2000
Larry Unroe Individual Corporate DirectorBoard of Directors Jan 1, 2015
Colleen Cook Individual Corporate DirectorBoard of Directors Jan 1, 2010
Elizabeth a Helmick Individual Corporate DirectorBoard of Directors Feb 1, 2021
Christopher Alexander Cockerham Individual Corporate DirectorBoard of Directors Jan 1, 2020
Thomas Danford Individual Corporate DirectorBoard of Directors Jun 2, 2008
Scott Silvestri Individual Corporate OfficerCfo May 1, 2019
Michael Archer Individual Corporate DirectorChairperson Board of Directors Jan 1, 2005
Gregg M Emerick Individual Corporate DirectorBoard of Directors Jan 1, 2019
Stephen C Keiser Individual Corporate DirectorBoard of Directors Jan 1, 2019
John Lee Individual Corporate DirectorBoard of Directors Jan 1, 2015

Owners & managing parties with NPI records 3

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1386699197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501323",
            "telephone_number": "740-568-2048",
            "fax_number": "740-568-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 COLEGATE DR",
            "city": "MARIETTA",
            "state": "OH",
            "postal_code": "457501323",
            "telephone_number": "740-568-2040",
            "fax_number": "740-568-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELBY GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SELBY GENERAL HOSPITAL",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-568-2000"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7943257",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001482000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hospital.provider@mmhs.medicity.net",
            "affiliation": "N",
            "address_1": "1106 Colegate Dr",
            "city": "Marietta",
            "state": "OH",
            "country_code": "US",
            "postal_code": "457501323",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Swing Bed Unit",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Marietta, OH

Sources for this page

Verify at the official NPI Registry.