NPIMap

Organization Active NPI

Camden on Gauley Medical Center, Inc.

Doing business as Camden Family Health

  • Federally Qualified Health Center (FQHC)
  • Summersville, WV
National Provider Identifier
1669947222
Registry record updated Oct 10, 2018
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
Practice address
70 Grade School Lane
Summersville, WV 26651
Phone
(304) 226-5725
NPI assigned
Oct 10, 2018
Last updated
Oct 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

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

Authorized official

Name
Margaret Hickey
Title
Ceo
Phone
(304) 226-5725

Specialties & licenses 1

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

Addresses

Primary practice location

70 Grade School Lane
Summersville, WV 26651

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 226-5725

Other names 1

  • Camden Family Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190208001340 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Summersville, WV
O20200423002284 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 20 practitioners
Practice locations: Summersville, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669947222. Details of each certification follow.

Federally qualified health center certification: CCN 511162

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2018
Last certification
Dec 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 31, 1979 in WV
Enrollment address
70 Grade School LN
Summersville, WV 26651-1897

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

National Provider Directory

National Provider Directory
Tax ID family
Camden on Gauley Medica21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

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
Roy Moose Individual Corporate DirectorBoard Member Jan 1, 2010 100%
Paula Fields Individual Corporate DirectorBoard Member Jan 1, 2010 100%
David Martin Individual Corporate DirectorBoard Member Jan 1, 1989 100%
Rachel Gohil Individual Corporate DirectorBoard Member Nov 26, 2012 100%
Michael Burke Individual Corporate DirectorBoard Member Oct 24, 2016 100%
Sharon Hanna Individual Corporate DirectorBoard Member Jan 1, 1981 100%
Margaret Hickey Individual Corporate Officer Mar 1, 2011
James Gamble Individual Corporate DirectorBoard Member Jan 1, 1989 100%
Melissa Rogers Individual W-2 Managing Employee Mar 24, 2014

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 47

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 47

NPI Registry JSON

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1669947222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 GRADE SCHOOL LANE",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "26651",
            "telephone_number": "304-226-5725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "MARGARET",
        "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",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summersville, WV

Sources for this page

Verify at the official NPI Registry.