NPIMap

Organization Active NPI

Mental Health Services for Clark Co Inc.

Doing business as Mental Health Services for Clark and Madison Counties, Inc.

  • Psychiatric Hospital
  • Springfield, OH
National Provider Identifier
1417948407
Registry record updated May 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
PPH-05-2406 Issued in OH
Legal business name
MENTAL HEALTH SERVICES FOR CLARK CO INC.
Doing business as
Mental Health Services for Clark and Madison Counties, Inc.
Practice address
474 North Yellow Springs Street
Springfield, OH 45504-2463
Phone
(937) 399-9500
Fax
(937) 342-4242
NPI assigned
Oct 31, 2005
Last updated
May 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2021

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

Authorized official

Name
Kelly L RiggerNPI 1982667192
Title
Ceo
Phone
(937) 399-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X PPH-05-2406 OH Primary

Addresses

Primary practice location

474 North Yellow Springs Street
Springfield, OH 45504-2463

Mailing address

474 North Yellow Springs Street
Springfield, OH 45504
Phone (937) 399-9500

Other identifiers 1

IdentifierTypeStateIssuer
2357962MedicaidOH

Other names 1

  • Mental Health Services for Clark and Madison Counties, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070508000189 OH Part A Provider - Hospital 7810801032 Practice locations: Springfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417948407. Details of each certification follow.

Hospital certification: CCN 364040

Legal name
MENTAL HEALTH SERVICES FOR CLARK CO INC
Doing business as
MENTAL HEALTH SERVICES FOR CLARK AND MADISON COUNTIES INC
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jan 1, 2003
Last certification
Dec 13, 2006
Beds
26
Ownership / control type
Private (for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 1969 in OH
Enrollment address
474 N Yellow Springs St
Springfield, OH 45504-2463
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mental Health Services for Clark and Madison CosCCN 364040 · All quality measures
Type
Psychiatric
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Mental Health Serv for6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Tracey Stute Individual Corporate DirectorBoard Member Jul 20, 2023 8%
Timothy P Dotson Individual Corporate DirectorBoard Member Jul 1, 2019 8%
Dana Engle Individual Corporate DirectorBoard Member Sep 1, 2022 8%
Edna Chapman Individual Corporate DirectorBoard Member Jul 1, 2020 8%
Ronald Gordon Individual Corporate DirectorBoard Member Dec 1, 2022 8%
Joan M Scofield Individual Corporate DirectorBoard Member Sep 5, 2019 9%
Kalpana K Vishnupad Individual W-2 Managing EmployeeMedical Director Jul 1, 2020
Brian a Smith Individual Corporate DirectorBoard Member Jul 1, 2023 9%
Jill R Sokolnicki Individual W-2 Managing EmployeeChief Operating Officer Jul 1, 2020
Kelly L Rigger Individual Corporate OfficerCeo Jun 3, 2019
W-2 Managing EmployeeCeo Jun 3, 2019
Evan Curtin Individual Corporate DirectorBoard Member Jul 1, 2024 8%
Sunil Dhingra Individual Corporate DirectorBoard Member Jul 20, 2023 8%
Mark Huff Individual W-2 Managing EmployeeCfo Dec 18, 2023
Jeffrey Hughes Individual 5% Or Greater Direct Ownership InterestBoard Member Jul 1, 2025 8%
Doug Schantz Individual Corporate DirectorBoard President Jul 1, 2019 9%

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

Practitioners 3

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": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620691200000",
    "number": "1417948407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 NORTH YELLOW SPRINGS STREET",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45504",
            "telephone_number": "937-399-9500",
            "fax_number": "937-342-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 NORTH YELLOW SPRINGS STREET",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "455042463",
            "telephone_number": "937-399-9500",
            "fax_number": "937-342-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTAL HEALTH SERVICES FOR CLARK CO INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A",
        "authorized_official_last_name": "RIGGER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "937-399-9500"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "OH",
            "license": "PPH-05-2406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2357962",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mental Health Services for Clark and Madison Counties, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mental Health Services for Clark and Madison Counties, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OH

Sources for this page

Verify at the official NPI Registry.