NPIMap

Organization Active NPI

Holzer Medical Center Jackson

  • Critical Access Hospital
  • Jackson, OH
National Provider Identifier
1669410940
Registry record updated May 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
HOLZER MEDICAL CENTER JACKSON
Practice address
500 Burlington Rd
Jackson, OH 45640-9360
Phone
(740) 395-8500
Fax
(740) 395-8502
NPI assigned
Jun 2, 2006
Last updated
May 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2018

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

Authorized official

Name
Michael R Canady, MDNPI 1396798948
Title
Ceo
Phone
(740) 446-5051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X OH Primary
Clinical Medical Laboratory 291U00000X NU

Addresses

Primary practice location

500 Burlington Rd
Jackson, OH 45640-9360

Mailing address

500 Burlington Rd
Jackson, OH 45640-9360
Phone (740) 395-8500

Other identifiers 1

IdentifierTypeStateIssuer
2224195MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060628000007 OH Part A Provider - Critical Access Hospital 0244147239 Practice locations: Jackson, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669410940. Details of each certification follow.

Hospital certification: CCN 361320

Legal name
HOLZER MEDICAL CENTER JACKSON
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2004
Last certification
Dec 12, 2019
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 8, 2000 in OH
Enrollment address
500 Burlington Rd
Jackson, OH 45640-9360
Other Hospital Practice Location

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
Holzer Medical Center JacksonCCN 361320 · All quality measures
Overall star rating
3 of 5
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

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
Gerald Roach Individual Corporate Officer Jan 1, 2024
Paul Reed Individual Corporate DirectorBoard Member Oct 17, 2007
Robert Wade Pugh Individual Corporate DirectorBoard Member Dec 1, 2016
Lori Harrison Individual W-2 Managing EmployeeCredentialing Coordinator Jul 14, 2014
Shana R Booher Individual Corporate DirectorDirector of Credentialing Jan 1, 2020
Craig Alan Mason Individual W-2 Managing EmployeeCredentialing Coordinator Sep 26, 2022
Rodney Barry Stout Individual Corporate OfficerChief Executive Officer Jan 1, 2024
Robert Grillo Individual Corporate DirectorBoard Member Oct 17, 2007
Larry Kidd Individual Corporate DirectorBoard Member Oct 17, 2007
Holzer Health System Organization, Gallipolis, OH Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000 100%
Michael Haynes Individual Corporate OfficerChief Financial Officer Jan 1, 2017
Nicolette M Jones Individual Corporate OfficerChief Medical Officer Jan 1, 2024
Tom Wiseman Individual Corporate DirectorBoard Member Jan 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.

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 149

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

View all 149

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525824000000",
    "number": "1669410940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 BURLINGTON RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409360",
            "telephone_number": "740-395-8500",
            "fax_number": "740-395-8502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BURLINGTON RD",
            "city": "JACKSON",
            "state": "OH",
            "postal_code": "456409360",
            "telephone_number": "740-395-8500",
            "fax_number": "740-395-8502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLZER MEDICAL CENTER JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2018-05-09",
        "status": "A",
        "authorized_official_last_name": "CANADY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "740-446-5051",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2224195",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, OH

Sources for this page

Verify at the official NPI Registry.