NPIMap

Camden on Gauley Medical Center, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Summersville, WV

NPI 1669947222 · NPPES record last updated Oct 10, 2018

Key facts

NPI
1669947222
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER, INC.
Practice address
70 Grade School Lane
Summersville, WV 26651
Phone
(304) 226-5725
NPI assigned
Oct 10, 2018
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 3

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

Other NPIs with the same Medicare PAC ID 24

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

Corporate family (same tax ID) 20

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

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WV

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
Corporation · Non-profit
Incorporated
Oct 31, 1979 in WV
Enrollment address
70 Grade School LN
Summersville, WV 26651-1897

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 Director
Board Member		 Jan 1, 2010 100%
Paula Fields
Individual 		Corporate Director
Board Member		 Jan 1, 2010 100%
David Martin
Individual 		Corporate Director
Board Member		 Jan 1, 1989 100%
Rachel Gohil
Individual 		Corporate Director
Board Member		 Nov 26, 2012 100%
Michael Burke
Individual 		Corporate Director
Board Member		 Oct 24, 2016 100%
Sharon Hanna
Individual 		Corporate Director
Board Member		 Jan 1, 1981 100%
Margaret Hickey
Individual 		Corporate Officer Mar 1, 2011
James Gamble
Individual 		Corporate Director
Board 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 Health
Craigsville, WV · CCN 511091		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center Inc
Summersville, WV · CCN 511145		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Medicare enrollment records

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

National Provider Directory

Tax ID family
Camden on Gauley Medical Center Inc (21 organizations share this tax ID)

Specialties & licenses

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

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

  • Camden Family Health Doing business as

Other providers in Summersville, WV

All providers in Summersville, WV · Federally Qualified Health Center (FQHC) in West Virginia

Sources for this page

Verify at the official NPI Registry.