NPIMap

Organization Active NPI

Adams County Regional Medical Center

Doing business as ACRMC Family Medicine-Georgetown

  • Rural Health Clinic/Center
  • Georgetown, OH
National Provider Identifier
1629628920
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Doing business as
ACRMC Family Medicine-Georgetown
Practice address
4881 State Route 125
Georgetown, OH 45121-9550
Phone
(937) 378-3075
NPI assigned
Sep 18, 2019
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Pete R Dagenbach
Title
Cfo
Phone
(937) 386-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

4881 State Route 125
Georgetown, OH 45121-9550

Mailing address

230 Medical Center Dr
Seaman, OH 45679-8002

Other names 1

  • ACRMC Family Medicine-Georgetown Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200128000331 OH Part A Provider - Rural Health Clinic 8921431131 Practice locations: Georgetown, OH
O20200427002166 OH Part B Supplier - Clinic/Group Practice 8921431131 Receives reassigned benefits from 47 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Georgetown, OH; Seaman, OH; West Union, OH; Winchester, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629628920. Details of each certification follow.

Rural health clinic certification: CCN 363418

Legal name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Doing business as
ADAMS COUNTY REGIONAL MEDICAL CENTER FAMILY MEDICINE (ACRMC)
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 14, 2019
Last certification
Aug 14, 2019
Ownership / control type
Non-profit – church related
Most recent change of ownership
Oct 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 31, 2016 in OH
Enrollment address
4881 State Route 125
Georgetown, OH 45121-9550
Related CCNs
361326

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Adams County Regional Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
David B Parrett Individual Contracted Managing EmployeeMedical Director Mar 18, 2020
Pete R Dagenbach Individual Corporate OfficerChief Financial Officer Oct 1, 2019
W-2 Managing EmployeeChief Financial Officer Oct 1, 2019
Matthew a Armstrong Individual Corporate DirectorDirector Oct 1, 2019
Alan Bird Individual Corporate OfficerCeo Oct 1, 2019
Corporate DirectorDirector Oct 1, 2019
Peoples Bank National Association Organization, Marietta, OH Financial institution 5% Or Greater Mortgage Interest Sep 30, 2024 80.7%
5% Or Greater Security Interest Sep 30, 2024 80.7%
Peggy Chalker Individual Corporate DirectorDirector Oct 1, 2019
Jack a McCoy Individual Corporate DirectorDirector Oct 1, 2019
Chad Wilson Individual Corporate DirectorDirector Oct 1, 2019
Roy Gustin Individual Corporate DirectorDirector Oct 1, 2019

Owners & managing parties with NPI records 2

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
Acrmc Family MedicineWinchester, OH, CCN 363431 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2019

Owned or controlled facilities with NPI records 1

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

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2019 Change of OwnershipThis provider was the buyer Adams County HospitalCCN 363418, OH, NPI 1821578246

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1629628920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 MEDICAL CENTER DR",
            "city": "SEAMAN",
            "state": "OH",
            "postal_code": "456798002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 STATE ROUTE 125",
            "city": "GEORGETOWN",
            "state": "OH",
            "postal_code": "451219550",
            "telephone_number": "937-378-3075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS COUNTY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "DAGENBACH",
        "authorized_official_first_name": "PETE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-386-3400"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACRMC Family Medicine-Georgetown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Georgetown, OH

Sources for this page

Verify at the official NPI Registry.