NPIMap

Organization Active NPI

Orrville Hospital Foundation

  • Rural Health Clinic/Center
  • Dover, OH
National Provider Identifier
1780465484
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ORRVILLE HOSPITAL FOUNDATION
Practice address
340 Oxford St Ste 120
Dover, OH 44622-1969
Phone
(330) 364-8889
NPI assigned
Oct 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Adam M Luntz
Title
Cfo
Phone
(330) 363-3889

Specialties & licenses 1

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

Addresses

Primary practice location

340 Oxford St Ste 120
Dover, OH 44622-1969

Mailing address

PO Box 80690
Canton, OH 44708-0690

Other names 1

  • Dover Health Center of Aultman Orrville Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231017000117 OH Part A Provider - Rural Health Clinic 7911890546 Practice locations: Dover, OH

Rural health clinic certification: CCN 363445

Legal name
ORRVILLE HOSPITAL FOUNDATION
Doing business as
DOVER HEALTH CENTER OF AULTMAN ORRVILLE HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 12, 2023
Last certification
Dec 12, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jan 31, 2023 in OH
Enrollment address
340 Oxford St
Ste 120
Dover, OH 44622-1969
Related CCNs
361323

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

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2275674Dover Health Center of340 Oxford Street Suite 120, Dover, OH 44622Certificate of waiverJan 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Orrville Hospital Foundation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

4205 Indian Hill Rd SE
Uhrichsville, OH 44683
Phone (330) 364-8889

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
Brian Belden Individual Corporate Director Jan 31, 2023 12.5%
Ronald R Lyons Individual Corporate Director Jan 31, 2023 12.5%
Mark Wright Individual Corporate Officer Jan 31, 2023 12.5%
Ryan S Jones Individual Corporate Officer Jan 31, 2023 12.5%
Aultman Health Foundation Organization, Canton, OH Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 2023 100%
Diane Jarrett Individual Corporate Director Jan 31, 2023 12.5%
Amelia E Laing Individual Corporate Officer Jan 31, 2023 12.5%
Adam Luntz Individual W-2 Managing Employee Jan 31, 2023
Rick Haines Individual Corporate Officer Jan 31, 2023 12.5%
Michael Hanke Individual Corporate Director Jan 31, 2023 12.5%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1696809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1780465484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80690",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447080690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 OXFORD ST STE 120",
            "city": "DOVER",
            "state": "OH",
            "postal_code": "446221969",
            "telephone_number": "330-364-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORRVILLE HOSPITAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-09",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "LUNTZ",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "330-363-3889"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dover Health Center of Aultman Orrville Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dover, OH

Sources for this page

Verify at the official NPI Registry.