NPIMap

Organization Active NPI

Commonwealth Regional Specialty Hospital, Inc.

  • Long Term Care Hospital
  • Bowling Green, KY
National Provider Identifier
1790715985
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
100404 Issued in KY
Legal business name
COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC.
Practice address
250 Park St
Sixth Floor
Bowling Green, KY 42101-1760
Phone
(270) 796-6200
Fax
(270) 796-6275
NPI assigned
Jul 3, 2006
Last updated
Jan 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Michele W Lawless
Title
Executive Vice President/Cfo
Phone
(270) 745-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 100404 KY Primary

Addresses

Primary practice location

250 Park St
Sixth Floor
Bowling Green, KY 42101-1760

Mailing address

PO Box 2697
Bowling Green, KY 42102-7697
Phone (270) 796-6288

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513000205 KY Part A Provider - Hospital 9335139351 Practice locations: Bowling Green, KY

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1790715985. Details of each certification follow.

Hospital certification: CCN 182005

Legal name
COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Feb 1, 2005
Last certification
Mar 7, 2018
Beds
28
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 12, 2003 in KY
Enrollment address
250 Park St
6
Bowling Green, KY 42101-1760
Other Hospital Practice Location
Hospital subgroups
Long-term

Hospital certification: CCN 180147

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COMMONWEALTH REGIONAL SPECIALTY HOSPITAL
Certification status
Terminated Other: provider status change, Jan 31, 2005
Provider type (POS)
Hospital – Short-term
Participating since
Jul 20, 2004
Last certification
Jul 7, 2004
Beds
28
Ownership / control type
Private (not for profit)
Facility address
250 Park Drive PO Box 90010 5TH Floor
Bowling Green, KY 42101

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Commonwealth Regional Specialty HospitalCCN 182005 · All quality measures
Ownership
Non-profit
Certified
Feb 1, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Beds
28

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
18D1024999Commonwealth Regional Specialty Hospital250 Park Street, 6a, Bowling Green, KY 42101Certificate of waiverApr 26, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

250 Park St
#6
Bowling Green, KY 42101
Phone (270) 796-6200

250 Park St
Fl Sixth
Bowling Green, KY 42101
Phone (270) 796-6200

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Vickie Elrod Individual Corporate DirectorDirector Jan 1, 2004
Wade Stone Individual Corporate OfficerExecutive Vice President Nov 14, 2012
W-2 Managing EmployeeExecutive Vice President Nov 14, 2012
Joe Davis Individual Corporate DirectorDirector Jan 1, 2004
Tom Forte Individual Corporate DirectorBoard Member Jan 1, 2015
Ghayth M Hammad Individual Corporate DirectorDirector Jan 1, 2014
Commonwealth Health Corporation, Inc. Organization, Bowling Green, KY Non-profit 5% Or Greater Direct Ownership Interest Dec 12, 2003 100%
Thomas Holderfield Individual Corporate DirectorDirector Jan 1, 2004
Susan Jones Individual Corporate DirectorBoard Member Jan 1, 2015
Michele Lawless Individual Corporate OfficerExec. Vice President & Cfo Aug 19, 2020
W-2 Managing EmployeeExec. Vice President & Cfo Aug 19, 2020
Cheri Natcher Individual Corporate DirectorDirector Jan 1, 2018
Connie Smith Individual Corporate OfficerPresident / Ceo Nov 17, 2010
W-2 Managing EmployeePresident / Ceo Nov 17, 2010
Christa Atkins Individual W-2 Managing EmployeeAdministrator Aug 24, 2015
David Gray Individual Corporate OfficerExec. Vice President Aug 19, 2020
W-2 Managing EmployeeExec. Vice President Aug 19, 2020

Owners & managing parties with NPI records 3

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

Facilities with the same owner 19

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

View all 19

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1790715985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2697",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421027697",
            "telephone_number": "270-796-6288",
            "fax_number": "270-796-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PARK ST",
            "address_2": "SIXTH FLOOR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011760",
            "telephone_number": "270-796-6200",
            "fax_number": "270-796-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH REGIONAL SPECIALTY HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "LAWLESS",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "270-745-1500"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "KY",
            "license": "100404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

Verify at the official NPI Registry.