NPIMap

Organization Active NPI

Southern Ohio Medical Center

Doing business as Hospice of Southern Ohio

  • Community Based Hospice Care Agency
  • Portsmouth, OH
National Provider Identifier
1780614719
Registry record updated Aug 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SOUTHERN OHIO MEDICAL CENTER
Doing business as
Hospice of Southern Ohio
Practice address
1805 27TH St
Portsmouth, OH 45662-2640
Phone
(740) 356-2651
Fax
(740) 356-2509
NPI assigned
Jul 4, 2006
Last updated
Aug 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN OHIO MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2020

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

Authorized official

Name
Mr. Dean Wray
Title
Vice President of Finance
Phone
(740) 356-8540

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary
Inpatient Hospice 315D00000X NU

Addresses

Primary practice location

1805 27TH St
Portsmouth, OH 45662-2640

Mailing address

1805 27TH St
Portsmouth, OH 45662-2640
Phone (740) 356-7547

Other identifiers 1

IdentifierTypeStateIssuer
0820348MedicaidOH

Other names 1

  • Hospice of Southern Ohio Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120807000645 OH Part A Provider - Hospice 8325043383 Practice locations: Portsmouth, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780614719. Details of each certification follow.

Hospice certification: CCN 361545

Legal name
SOUTHERN OHIO MEDICAL CENTER
Doing business as
SOMC HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 1, 1990
Last certification
May 12, 2021
Ownership / control type
Proprietary - Other
Organization structure
CorporationNon-profit
Incorporated
Jul 6, 1990 in OH
Enrollment address
2201 25TH Street
Portsmouth, OH 45662

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Somc HospiceCCN 361545 · All quality measures
Ownership
For-Profit
Certified
Jun 1, 1990
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
South Shore Family Prac17 organizations share this tax ID, including this one
Part of
South Shore Family Prac

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Elie M Saab Individual Corporate Director Jan 1, 2021
Gary Duzan Individual Corporate Director Jan 1, 2021
Robert Dever Individual Corporate Director Jan 1, 2021
Ben Gill Individual Corporate Director Jan 1, 2021
David Fowler Individual Corporate Director Jan 1, 2021
Tom Reiser Individual Corporate Director Jan 1, 2021
George Lawson Individual Corporate Director Jan 1, 2021
Claudia L Burchett Individual Contracted Managing Employee Jul 1, 2016
Randal Arnett Individual Corporate OfficerOfficer Jul 1, 2012 100%
Kara Plummer Individual Corporate Officer Jan 1, 2021
Becky Thiel Individual Corporate Director Jan 1, 2021
Steven Conley Individual Corporate Director Jan 1, 2021
David K Byers Individual Corporate Director Jan 1, 2021
Matthew Miller Individual Corporate Director Jan 1, 2021
Teresa L Ruby Individual W-2 Managing EmployeeAdministrative Director of Hospi Jun 22, 2012
Tanya Jana C Escalona Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597622400000",
    "number": "1780614719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 27TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622640",
            "telephone_number": "740-356-7547",
            "fax_number": "740-356-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 27TH ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622640",
            "telephone_number": "740-356-2651",
            "fax_number": "740-356-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN OHIO MEDICAL CENTER",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-08-17",
        "certification_date": "2020-08-17",
        "status": "A",
        "authorized_official_last_name": "WRAY",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "740-356-8540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0820348",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Southern Ohio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hospice of Southern Ohio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portsmouth, OH

Sources for this page

Verify at the official NPI Registry.