NPIMap

Organization Active NPI

Carthage Area Hospital, Inc.

  • Rural Health Clinic/Center
  • Carthage, NY
National Provider Identifier
1750944310
Registry record updated Apr 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARTHAGE AREA HOSPITAL, INC.
Practice address
22075 Constitution Drive
Carthage, NY 13619
Phone
(315) 493-1000
Fax
(315) 493-0105
NPI assigned
Apr 19, 2019
Last updated
Apr 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2019

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

Authorized official

Name
Richard Duvall
Title
Ceo
Phone
(315) 519-5201

Specialties & licenses 1

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

Addresses

Primary practice location

22075 Constitution Drive
Carthage, NY 13619

Mailing address

1001 West St
Carthage, NY 13619-9776
Phone (315) 519-5724

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190604000372 NY Part A Provider - Rural Health Clinic 9931010485 Practice locations: Carthage, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750944310. Details of each certification follow.

Rural health clinic certification: CCN 333990

Legal name
CARTHAGE AREA HOSPITAL INC
Doing business as
CARTHAGE AREA HOSPITAL WALK IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 26, 2019
Last certification
Jul 16, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1965 in NY
Enrollment address
22075 Constitution Drive
Carthage, NY 13619
Related CCNs
331318

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Carthage Area Hosp32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dale Klock Individual Corporate DirectorGoverning Board Vice President May 1, 2010
Andrew R Manzer Individual Corporate OfficerInterim Ceo Mar 2, 2026
W-2 Managing EmployeeAd; Mar 2, 2026
Arnold R Hager Individual Corporate OfficerVP of Revenue Cycle Sep 1, 2025
Jerian O'Dell Individual Corporate OfficerCoo Apr 2, 2023
Mirza M Ashraf Individual Corporate Director May 1, 1992
Tim Sturick Individual Corporate DirectorGoverning Board Treasurer May 1, 2016
Gary Rowe Individual Corporate DirectorGoverning Board President May 1, 2007
Larry Hasseler Individual Corporate DirectorGoverning Board Secretary May 1, 2006

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555632000000",
    "number": "1750944310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 WEST ST",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "136199776",
            "telephone_number": "315-519-5724",
            "fax_number": "315-493-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22075 CONSTITUTION DRIVE",
            "city": "CARTHAGE",
            "state": "NY",
            "postal_code": "13619",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE AREA HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-04-19",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-519-5201"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, NY

Sources for this page

Verify at the official NPI Registry.