NPIMap

Organization Active NPI

Mary Rutan Hospital

Doing business as Mary Rutan Internal Medicine

  • Rural Health Clinic/Center
  • Bellefontaine, OH
National Provider Identifier
1407610074
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MARY RUTAN HOSPITAL
Doing business as
Mary Rutan Internal Medicine
Practice address
2231 Timber TRL
Bellefontaine, OH 43311-9036
Phone
(937) 599-3115
NPI assigned
Feb 13, 2024
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY RUTAN HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Thomas Denbow
Title
VP of Finance and Development
Phone
(937) 651-6688

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2231 Timber TRL
Bellefontaine, OH 43311-9036

Mailing address

2231 Timber TRL
Bellefontaine, OH 43311-9036
Phone (937) 599-3115

Other names 1

  • Mary Rutan Internal Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031124000531 OH Part B Supplier - Clinic/Group Practice 9032013792 Receives reassigned benefits from 132 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bellefontaine, OH; Waynesfield, OH; Urbana, OH; Saint Paris, OH; Russells Point, OH; Lima, OH; Lakeview, OH; Kenton, OH…
O20240424001504 OH Part A Provider - Rural Health Clinic 9032013792 Practice locations: Bellefontaine, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407610074. Details of each certification follow.

Rural health clinic certification: CCN 363880

Legal name
MARY RUTAN HOSPITAL
Doing business as
MARY RUTAN INTERNAL MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 3, 2024
Last certification
Dec 3, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 1983 in OH
Enrollment address
2231 Timber TRL
Bellefontaine, OH 43311-9036

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Madriver Family Pract12 organizations share this tax ID, including this one
Part of
Madriver Family Pract

Other organizations with this tax ID 11

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

Locations

1134 N Main St
Ste 1100
Bellefontaine, OH 43311
Phone (937) 651-6820

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
Thomas Denbow Individual Corporate OfficerVP of Finance & Development Jun 1, 2023
Corporate DirectorVP of Finance & Development Jun 1, 2023
Richard Gildow Individual Corporate DirectorBoard Director Jan 1, 1992
John Hatcher Individual Corporate DirectorBoard Director Mar 19, 2012
Charles Chamberlain Individual Corporate DirectorBoard Director Mar 18, 2013
Barbara Haushalter Individual Corporate DirectorBoard Director Mar 25, 2019
Stephen Shellhaas Individual Corporate DirectorBoard Director Mar 19, 2018
Jeffrey Holycross Individual Corporate DirectorBoard Director Mar 19, 2012
Scott a Abraham Individual Corporate DirectorBoard Director Mar 23, 2015
Christina M Myers Individual Corporate Officer Aug 30, 2021
Corporate DirectorVP of Operations Aug 30, 2021
Darin Olson Individual Corporate DirectorBoard Director Mar 23, 2015
Kelly J Kauffman Individual Corporate DirectorBoard Director Mar 27, 2023
Thomas Simon Individual Corporate DirectorBoard Director Mar 25, 2019
Chad a Ross Individual Contracted Managing EmployeePresident & Ceo Aug 30, 2021
Corporate OfficerPresident & Ceo Mar 23, 2015
Corporate DirectorPresident & Ceo Mar 23, 2015
John Reser Individual Corporate DirectorBoard Director Mar 20, 2006
Mary Rutan Health Association Organization, Bellefontaine, OH Corporation, Non-profit Operational/Managerial Control Dec 28, 1983 100%
Other Dec 28, 1983 100%
Dan S Willoby Individual Corporate Director Mar 27, 2023
Joenee D Purcell Individual Corporate DirectorBoard Director Mar 17, 2014
Matthew Verbsky Individual Corporate DirectorBoard Director Mar 19, 2007

Facilities with the same owner 3

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

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

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1707782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1407610074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2231 TIMBER TRL",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119036",
            "telephone_number": "937-599-3115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231 TIMBER TRL",
            "city": "BELLEFONTAINE",
            "state": "OH",
            "postal_code": "433119036",
            "telephone_number": "937-599-3115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY RUTAN HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY RUTAN HOSPITAL",
        "enumeration_date": "2024-02-13",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "DENBOW",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP OF FINANCE AND DEVELOPMENT",
        "authorized_official_telephone_number": "937-651-6688"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Rutan Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellefontaine, OH

Sources for this page

Verify at the official NPI Registry.