NPIMap

Organization Active NPI

Camden on Gauley Medical Center, Inc

Doing business as Camden Family Health (Cowen Location)

  • Federally Qualified Health Center (FQHC)
  • Cowen, WV
National Provider Identifier
1639418361
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER, INC
Doing business as
Camden Family Health (Cowen Location)
Practice address
56 Park Street
Cowen, WV 26206-3702
Phone
(304) 226-5275
NPI assigned
Jan 31, 2013
Last updated
Dec 10, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CAMDEN ON GAULEY MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Authorized official

Name
Margaret E Groves
Title
Ceo
Phone
(304) 226-5725

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

56 Park Street
Cowen, WV 26206-3702

Mailing address

56 Park Street
Cowen, WV 26206-3702

Other names 1

  • Camden Family Health (Cowen Location) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050209000321 WV Part B Supplier - Public Health/Welfare Agency 6002867850 Receives reassigned benefits from 43 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Camden on Gauley, WV; Upperglade, WV; Craigsville, WV; Summersville, WV
O20140109000363 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Cowen, WV
O20240416001782 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 24 practitioners
Practice locations: Cowen, WV

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1639418361. Details of each certification follow.

Federally qualified health center certification: CCN 581027

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2023
Last certification
Jun 19, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 30, 1979 in WV
Enrollment address
56 Park St
Cowen, WV 26206-3302

Federally qualified health center certification: CCN 511041

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CAMDEN FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2014
Last certification
Jan 9, 2014
Ownership / control type
For profit – corporation
Facility address
56 Park Street
Cowen, WV 26206

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Camden on Gauley Medica

Locations

56 Park St
Cowen, WV 26206
Phone (304) 226-5275

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
Roy Moose Individual Corporate DirectorBoard Member Jan 1, 2010
Elizabeth Snyder Individual Corporate DirectorBoard Member Jan 1, 1997
Barbara Butler Individual Corporate DirectorBoard Member Nov 18, 2019
Brandon Moll Individual Corporate DirectorBoard Member Aug 12, 2022
Sharon Hanna Individual Corporate DirectorBoard Member Jan 1, 1981
Margaret Hickey Individual Corporate OfficerCeo Mar 1, 2011
W-2 Managing EmployeeCeo Nov 8, 2013
Operational/Managerial ControlCeo Nov 8, 2013
James Gamble Individual Corporate Director Jan 1, 1989
Melissa Rogers Individual W-2 Managing Employee Nov 8, 2013
Tiffany Montgomery Individual Corporate DirectorBoard Member Mar 22, 2021
Jane Sherwood Individual Corporate DirectorBoard Member Aug 1, 2020

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Camden Family HealthCraigsville, WV, CCN 511091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center IncSummersville, WV, CCN 511145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1639418361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 PARK STREET",
            "city": "COWEN",
            "state": "WV",
            "postal_code": "262063702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 PARK STREET",
            "city": "COWEN",
            "state": "WV",
            "postal_code": "262063702",
            "telephone_number": "304-226-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMDEN ON GAULEY MEDICAL CENTER, INC",
        "enumeration_date": "2013-01-31",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "GROVES",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Health (Cowen Location)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Health (Cowen Location)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cowen, WV

Sources for this page

Verify at the official NPI Registry.