NPIMap

Organization Active NPI

Adena Fayette Medical Center

  • Critical Access Hospital
  • Washington Court House, OH
National Provider Identifier
1508978677
Registry record updated Jun 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1168 Issued in OH
Legal business name
ADENA FAYETTE MEDICAL CENTER
Practice address
1430 Columbus Ave
Washington Court House, OH 43160-1703
Phone
(740) 333-2705
Fax
(740) 333-2998
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2021

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

Authorized official

Name
Lisa M Carlson
Title
Cfo
Phone
(740) 779-7582

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 1168 OH
Critical Access Hospital 282NC0060X 1168 OH Primary

Addresses

Primary practice location

1430 Columbus Ave
Washington Court House, OH 43160-1703

Mailing address

1450 Columbus Ave
Suite B 6-7-8
Washington Court House, OH 43160-3701
Phone (740) 333-2236

Other identifiers 8

IdentifierTypeStateIssuer
0066355OtherAETNA INSURANCE
316008062044OtherMEDICAL MUTUAL INSURANCE
000000244918OtherANTHEM INSURANCE
0653982OtherCIGNA INSURANCE
5020091OtherUNITED HEALTHCARE INSURAN
316008062OtherALL OTHER PAYERS
2675403MedicaidOH
34OtherCENTRAL BENEFITS INSURANC

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210610002685 OH Part A Provider - Critical Access Hospital 5294134664 Practice locations: Washington Court House, OH
O20220805001729 OH Part A Provider - Critical Access Hospital 5294134664 Practice locations: Washington Court House, OH

Hospital certification: CCN 361331

Legal name
ADENA FAYETTE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2005
Last certification
Jan 27, 2011
Beds
25
Ownership / control type
Local
Most recent change of ownership
May 2, 2021 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 2021 in OH
Enrollment address
1430 Columbus Ave
Washington Court House, OH 43160-1703
Other Hospital Practice Location

Hospital certification: CCN 36Z331

Legal name
ADENA FAYETTE MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 2021
Enrollment address
1430 Columbus Ave
Washington Court House, OH 43160-1703
Hospital Swing-Bed Unit

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

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
Adena Fayette Medical CenterCCN 361331
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Fayette County
    • Public Health & General Preventive Medicine Physician
    • Washington CH, OH
    • NPI 1477602811

    Member Of

    NPD member

Locations

4 N Main St
Jeffersonville, OH 43128
Phone (740) 335-6137

1430 Columbus Ave
Ste 201
Washington Court House, OH 43160
Phone (740) 333-3333

1450 Columbus Ave
Ste 678
Washington Court House, OH 43160

1510 Columbus Ave
Ste 130
Washington Court House, OH 43160
Phone (740) 333-2878

1510 Columbus Ave
Ste 230
Wshngtn Ct Hs, OH 43160
Phone (740) 333-3333

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Donald M Diener Individual Corporate OfficerSenior Operations Executive Offi May 2, 2021
W-2 Managing EmployeeSenior Operations Executive Offi May 2, 2021
Corporate OfficerCeo Aug 15, 2016
Corporate DirectorCeo Aug 15, 2016
W-2 Managing EmployeeCeo Aug 15, 2016
Operational/Managerial ControlCeo Aug 15, 2016
Lisa Henness Individual W-2 Managing EmployeeExec Assistant to Cfo May 2, 2021
Jennifer Breedlove Individual Corporate DirectorBoard Member May 2, 2021
Corporate DirectorTrustee Mar 25, 2020
Operational/Managerial ControlTrustee Mar 25, 2020
Lisa M Carlson Individual Corporate OfficerChief Financial Officer May 2, 2021
W-2 Managing EmployeeChief Financial Officer May 2, 2021
Sharon Wisecup Individual W-2 Managing EmployeeVP System Finance May 2, 2021
W-2 Managing EmployeeVP System Finaince May 2, 2021
Myron Priest Individual Corporate DirectorBoard Member May 2, 2021
Corporate DirectorTrustee Nov 21, 2016
Operational/Managerial ControlTrustee Nov 21, 2016
Brian Ream Individual Corporate DirectorBoard Member May 2, 2021
Corporate DirectorTrustee Mar 6, 2017
Operational/Managerial ControlTrustee Mar 7, 2016
Mark Richards Individual Corporate DirectorBoard Member May 2, 2021
Corporate DirectorTrustee Mar 7, 2016
Operational/Managerial ControlTrustee Mar 7, 2016
Adena Health System Organization, Chillicothe, OH Non-profit Operational/Managerial Control May 2, 2021
Trent J Lemle Individual Corporate OfficerCfo Jun 29, 2017
Corporate DirectorCfo Jun 29, 2017
W-2 Managing EmployeeCfo Jun 29, 2017
Operational/Managerial ControlCfo Jun 29, 2017
Tammie J Wilson Individual Corporate OfficerChief Nursing Officer Nov 2, 2015
Corporate DirectorCno Nov 2, 2015
W-2 Managing EmployeeChief Nursing Officer Nov 2, 2015
Operational/Managerial ControlChief Nursing Officer Nov 2, 2015
Fayette County Organization, Washington Court House, OH 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Operational/Managerial Control Aug 15, 2016
Ralph Stegbauer Individual Corporate DirectorTrustee Apr 24, 2019
Operational/Managerial ControlTrustee Apr 24, 2019

Owners & managing parties with NPI records 3

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

Affiliated clinicians 229

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

View all 229

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1508978677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 COLUMBUS AVE",
            "address_2": "SUITE B 6-7-8",
            "city": "WASHINGTON COURT HOUSE",
            "state": "OH",
            "postal_code": "431603701",
            "telephone_number": "740-333-2236",
            "fax_number": "740-333-3881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 COLUMBUS AVE",
            "city": "WASHINGTON COURT HOUSE",
            "state": "OH",
            "postal_code": "431601703",
            "telephone_number": "740-333-2705",
            "fax_number": "740-333-2998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADENA FAYETTE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "740-779-7582"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "OH",
            "license": "1168",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OH",
            "license": "1168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA INSURANCE",
            "identifier": "0066355",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MUTUAL INSURANCE",
            "identifier": "316008062044",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM INSURANCE",
            "identifier": "000000244918",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA INSURANCE",
            "identifier": "0653982",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE INSURAN",
            "identifier": "5020091",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER PAYERS",
            "identifier": "316008062",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2675403",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CENTRAL BENEFITS INSURANC",
            "identifier": "34",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington Court House, OH

Sources for this page

Verify at the official NPI Registry.