NPIMap

Organization Active NPI

Orleans Community Health

Doing business as Medina Memorial Hospital

  • Critical Access Hospital
  • Medina, NY
National Provider Identifier
1609873520
Registry record updated Oct 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
3622700C Issued in NY
Legal business name
ORLEANS COMMUNITY HEALTH
Doing business as
Medina Memorial Hospital
Practice address
200 Ohio St
Medina, NY 14103
Phone
(585) 798-2000
Fax
(585) 798-8444
NPI assigned
Jul 7, 2005
Last updated
Oct 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2021

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

Authorized official

Name
Mark Shurtz
Title
C.E.O.
Phone
(585) 798-8101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 3622700C NY Primary

Addresses

Primary practice location

200 Ohio St
Medina, NY 14103

Mailing address

200 Ohio St
Medina, NY 14103
Phone (585) 798-2000

Other identifiers 1

IdentifierTypeStateIssuer
3622700COtherNYLICENSE

Other names 1

  • Medina Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040504000620 NY Part B Supplier - Clinic/Group Practice 7315857018 Receives reassigned benefits from 47 practitioners
1 other NPI on this enrollment
Practice locations: Albion, NY; Medina, NY
O20140925000107 NY Part A Provider - Critical Access Hospital 7315857018 Practice locations: Medina, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609873520. Details of each certification follow.

Hospital certification: CCN 331319

Legal name
ORLEANS COMMUNITY HEALTH
Doing business as
MEDINA MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 26, 2015
Last certification
Feb 6, 2025
Beds
34
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1908 in NY
Enrollment address
200 Ohio St
Medina, NY 14103-1063
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Medina Memorial HospitalCCN 331319 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

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 13

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

NameRoleSinceShare
Dale W Sponaugle Individual Corporate DirectorBoard Member Aug 27, 2014
Lance J Mark Individual Corporate DirectorBoard of Director Apr 1, 2020
Marc Shurtz Individual Corporate OfficerCeo Jul 29, 2020
David G Monti Individual Corporate DirectorBoard Member Apr 1, 2004
Lori Condo Individual W-2 Managing EmployeeAccountant Aug 28, 2014
Kevin Foley Individual Corporate DirectorBoard of Directors Apr 1, 2017
Lynn Johnson Individual Corporate DirectorBoard Member Apr 1, 2018
April McGaffick Individual Corporate DirectorBoard Member Apr 1, 2012
Joseph M Misiti Individual Corporate DirectorBoard Member Apr 1, 2013
Cynthia Hewitt Individual Corporate DirectorBoard Member Apr 1, 2004
Dawn Meland Individual Corporate DirectorBoard Member Apr 1, 2005
Shannon Blount Individual Corporate DirectorBoard Member Apr 1, 2018
Richard Steven Elman Individual Corporate DirectorBoard of Director Apr 1, 2021

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 48

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.

View all 48

Affiliated clinicians 96

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

View all 96

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634256000000",
    "number": "1609873520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OHIO ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "14103",
            "telephone_number": "585-798-2000",
            "fax_number": "585-798-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 OHIO ST",
            "city": "MEDINA",
            "state": "NY",
            "postal_code": "14103",
            "telephone_number": "585-798-2000",
            "fax_number": "585-798-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORLEANS COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2021-10-15",
        "certification_date": "2021-10-15",
        "status": "A",
        "authorized_official_last_name": "SHURTZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "585-798-8101"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NY",
            "license": "3622700C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "3622700C",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medina Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medina Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Medina, NY

Sources for this page

Verify at the official NPI Registry.