NPIMap

Organization Active NPI

Montgomery General Hospital, Inc

  • Critical Access Hospital
  • Montgomery, WV
National Provider Identifier
1619913647
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
72 Issued in WV
Legal business name
MONTGOMERY GENERAL HOSPITAL, INC
Practice address
401 6TH Ave
Montgomery, WV 25136-2116
Phone
(304) 442-5151
Fax
(304) 442-7494
NPI assigned
Jun 20, 2006
Last updated
Apr 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Authorized official

Name
Sherri Murray
Title
Cfo
Phone
(304) 442-1246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 72 WV Primary

Addresses

Primary practice location

401 6TH Ave
Montgomery, WV 25136-2116

Mailing address

401 6TH Ave
Montgomery, WV 25136-2116
Phone (304) 442-5151

Other identifiers 6

IdentifierTypeStateIssuer
000303151OtherWVBLUE CROSS BLUE SHIELD
3810001695MedicaidWV
0001386000MedicaidWV
0001386003MedicaidWV
032083700OtherWVBLACK LUNG
3810001437MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, KY, OH5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040108000241 WV Part B Supplier - Clinic/Group Practice 6204735269 Receives reassigned benefits from 96 practitioners
1 other NPI on this enrollment
Practice locations: Montgomey, WV
O20050110000040 WV Part A Provider - Critical Access Hospital 6204735269 Receives reassigned benefits from 24 practitioners
Practice locations: Montgomery, WV
O20210119000334 WV Part A Provider - Rural Health Clinic 6204735269 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montgomery, WV
O20260511003505 KY Part B Supplier - Clinic/Group Practice 6204735269 Practice locations: Ashland, KY; Crestwood, KY; Fort Thomas, KY; Lexington, KY; Louisville, KY
O20260513001717 OH Part B Supplier - Clinic/Group Practice 6204735269 Receives reassigned benefits from 13 practitioners
Practice locations: Peninsula, OH; Portsmouth, OH; Upper Arlington, OH; Wheelersburg, OH; Wintersville, OH; Oakwood, OH; Olmsted TWP, OH; Bellbrook, OH…

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1619913647. Details of each certification follow.

Hospital certification: CCN 511318

Legal name
MONTGOMERY GENERAL HOSPITAL, INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 1, 2005
Last certification
Jan 8, 2025
Beds
69 (25 certified)
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1970 in WV
Enrollment address
401 6TH Ave
Montgomery, WV 25136-2116

Rural health clinic certification: CCN 513428

Legal name
MONTGOMERY GENERAL HOSPITAL, INC
Doing business as
MONTGOMERY PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 22, 2021
Last certification
Mar 22, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1970 in WV
Enrollment address
401 6TH Ave
Ste 301
Montgomery, WV 25136-2116
Related CCNs
511318

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Montgomery General HospitalCCN 511318 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Barbara Crist Individual Corporate Director Nov 5, 2010
Corporate Director Apr 1, 2020
Vickie Gay Individual Corporate Director Feb 2, 2005
Operational/Managerial ControlPresident and Ceo Jul 29, 1996 100%
Patsy C Tucker Individual Corporate Director Nov 5, 2010
Corporate Director Apr 1, 2020
Raleigh L Collins Individual Corporate Director Nov 5, 2010
Corporate Director Apr 1, 2020
Donald L Smith Individual Corporate Director Nov 5, 2010
Corporate Director Apr 1, 2020
Sherri L Murray Individual Corporate Director Feb 2, 2005
W-2 Managing Employee Apr 1, 2020
Operational/Managerial Control Apr 1, 2020
Ghassan Y Dagher Individual Corporate Director Nov 5, 2010
Joyce Brown Individual Corporate Director Apr 1, 2020
Ainsley J Toney Individual W-2 Managing Employee Jan 1, 2026
Deborah a a Hill Individual Corporate DirectorCeo Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Operational/Managerial ControlCeo Jan 1, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Montgomery PediatricsMontgomery, WV, CCN 513429 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Other (100%)		 Apr 1, 2020
Apr 1, 2020
Apr 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 115

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 115

Affiliated clinicians 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1619913647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 6TH AVE",
            "city": "MONTGOMERY",
            "state": "WV",
            "postal_code": "251362116",
            "telephone_number": "304-442-5151",
            "fax_number": "304-442-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 6TH AVE",
            "city": "MONTGOMERY",
            "state": "WV",
            "postal_code": "251362116",
            "telephone_number": "304-442-5151",
            "fax_number": "304-442-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY GENERAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "MURRAY",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-442-1246"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WV",
            "license": "72",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000303151",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001695",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001386000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001386003",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "032083700",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810001437",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, WV

Sources for this page

Verify at the official NPI Registry.