Commonwealth Regional Specialty Hospital, Inc.
Organization Active NPI Long Term Care Hospital · Bowling Green, KY
NPI 1790715985 · NPPES record last updated Jan 11, 2023
Key facts
- NPI
- 1790715985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Long Term Care Hospital 282E00000X
- License
- 100404 (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
- Organization subpart
- No
Authorized official
- Name
- Michele W Lawless
- Title
- Executive Vice President/Cfo
- Phone
- (270) 745-1500
Owners & managing parties with NPI records 3
Member of 1
Facilities with the same owner 19
Affiliated clinicians 3
-
Anson Hsieh, MD
-
Sanjay Kaul, MD
Medicare Care Compare: Long-term care hospital
- Listed as
- Commonwealth Regional Specialty Hospital
- Ownership
- Non-profit
- Certified
- Feb 1, 2005
- Medicare certification status
- Active
- Beds
- 28
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D1024999 | Commonwealth Regional Specialty Hospital | Certificate of waiver | Apr 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
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
- Corporation · Non-profit
- Incorporated
- Dec 12, 2003 in KY
- Enrollment address
- 250 Park St
6
Bowling Green, KY 42101-1760 - Hospital subgroups
- Long-term
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Vickie Elrod |
Corporate Director |
Jan 1, 2004 | |
| Wade Stone |
Corporate Officer |
Nov 14, 2012 | |
| W-2 Managing Employee |
Nov 14, 2012 | ||
| Joe Davis |
Corporate Director |
Jan 1, 2004 | |
| Tom Forte |
Corporate Director |
Jan 1, 2015 | |
| Ghayth M Hammad |
Corporate Director |
Jan 1, 2014 | |
| Commonwealth Health Corporation, Inc. |
5% Or Greater Direct Ownership Interest | Dec 12, 2003 | 100% |
| Thomas Holderfield |
Corporate Director |
Jan 1, 2004 | |
| Susan Jones |
Corporate Director |
Jan 1, 2015 | |
| Michele Lawless |
Corporate Officer |
Aug 19, 2020 | |
| W-2 Managing Employee |
Aug 19, 2020 | ||
| Cheri Natcher |
Corporate Director |
Jan 1, 2018 | |
| Connie Smith |
Corporate Officer |
Nov 17, 2010 | |
| W-2 Managing Employee |
Nov 17, 2010 | ||
| Christa Atkins |
W-2 Managing Employee |
Aug 24, 2015 | |
| David Gray |
Corporate Officer |
Aug 19, 2020 | |
| W-2 Managing Employee |
Aug 19, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040513000205 | KY | Part a Provider - Hospital | 9335139351 | Practice locations: Bowling Green, KY |
National Provider Directory
Locations
250 Park St
Fl Sixth
Bowling Green, KY 42101
Phone (270) 796-6200
250 Park St
Fl 6
Bowling Green, KY 42101
Phone (270) 796-6200
250 Park St
#6
Bowling Green, KY 42101
Phone (270) 796-6200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Hospital | 282E00000X | 100404 | KY | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01000355 | Medicaid | KY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Bowling Green, KY
- Commonwealth Health Free Clinic, Inc
- Commonwealth Health Free Clinic, Inc.
- Commonwealth of Kentucky
- Commonwealth Pain Associates PLLC
- Commonwealth Pain Associates PLLC
- Commonwealth Surgical Services, LLC
- Commonwealth Surgical Services, LLC
- Community Action of Southern Kentucky
- Community Action of Southern Kentucky
- Community Action of Southern Kentucky
All providers in Bowling Green, KY · Long Term Care Hospital in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.