NPIMap

Organization Active NPI

Charles Cole Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Coudersport, PA
National Provider Identifier
1487616470
Registry record updated Nov 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
031801 Issued in PA
Legal business name
CHARLES COLE MEMORIAL HOSPITAL
Practice address
1001 E 2ND St
Coudersport, PA 16915
Phone
(814) 274-9300
NPI assigned
Apr 5, 2006
Last updated
Nov 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2023

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

Authorized official

Name
Roger C. Yost
Title
Cfo
Phone
(570) 321-3175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 031801 PA Primary

Addresses

Primary practice location

1001 E 2ND St
Coudersport, PA 16915

Mailing address

1001 E 2ND St
Coudersport, PA 16915
Phone (814) 274-9300

Other identifiers 1

IdentifierTypeStateIssuer
100001127-0106MedicaidPA

Other names 1

  • Swing Bed Program Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070730000820 PA Part A Provider - Critical Access Hospital 3779487475 Practice locations: Coudersport, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487616470. Details of each certification follow.

Hospital certification: CCN 39Z313

Legal name
CHARLES COLE MEMORIAL HOSPITAL
Doing business as
UPMC COLE
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1910 in PA
Enrollment address
1001 East Second St
Coudersport, PA 16915-8161
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Charles Cole Mem Hos51 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Terrance L Foust Individual Corporate OfficerExec Officio - Chief of Staff Nov 10, 2022
Michael Callahan Individual Corporate OfficerBoard Member Oct 1, 2020
Matthew Splain Individual Corporate OfficerBoard Member Mar 16, 2022
Patricia Jackson Gehris Individual Corporate OfficerBoard Member Jun 15, 2022
Daniel James Glunk Individual Corporate OfficerBoard Member Nov 10, 2022
Patrick Larsen Individual Corporate OfficerSecretary Feb 29, 2024
Josh Costa Individual Corporate OfficerBoard Member Mar 16, 2022
Carrie Ennis Individual Corporate OfficerBoard Member Mar 1, 2018
Elizabeth Wallace Individual Corporate OfficerVice Chair Feb 29, 2024
Connie J Perkins Individual Corporate OfficerBoard Member Nov 10, 2022
Melynda Budd Individual Corporate OfficerTreasurer Feb 29, 2024
Roger C Yost Individual Corporate OfficerCfo Jan 4, 2024
W-2 Managing EmployeeNcpa Cfo Jan 4, 2024
Upmc Organization, Pittsburgh, PA Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2018 100%
Mary Ann Rigas Individual Corporate DirectorBoard Member Oct 7, 2019
David Lopatofsky Individual Corporate OfficerBoard Member Mar 1, 2018
John Leete Individual Corporate OfficerChair Feb 29, 2024

Owners & managing parties with NPI records 4

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

Facilities with the same owner 63

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

View all 63

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 3

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": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698796800000",
    "number": "1487616470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E 2ND ST",
            "city": "COUDERSPORT",
            "state": "PA",
            "postal_code": "16915",
            "telephone_number": "814-274-9300",
            "fax_number": "814-274-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E 2ND ST",
            "city": "COUDERSPORT",
            "state": "PA",
            "postal_code": "16915",
            "telephone_number": "814-274-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES COLE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2023-11-01",
        "certification_date": "2023-11-01",
        "status": "A",
        "authorized_official_last_name": "YOST",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-321-3175"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "PA",
            "license": "031801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100001127-0106",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swing Bed Program",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Swing Bed Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coudersport, PA

Sources for this page

Verify at the official NPI Registry.