NPIMap

Organization Active NPI

Mercy Health - Willard Hospital LLC

Doing business as Mercy Health - Willard Hospital

  • Critical Access Hospital
  • Willard, OH
National Provider Identifier
1790731016
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MERCY HEALTH - WILLARD HOSPITAL LLC
Doing business as
Mercy Health - Willard Hospital
Practice address
1100 Neal Zick Road
Willard, OH 44890-9287
Phone
(419) 964-5000
Fax
(419) 964-5178
NPI assigned
May 26, 2006
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Ms. Buffy Lynn Detterman
Title
Ceo
Phone
(419) 455-7074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1100 Neal Zick Road
Willard, OH 44890-9287

Mailing address

PO Box 636547
Cincinnati, OH 45263-6547
Phone (419) 964-5000

Other names 2

  • Mercy Health - Willard Hospital Doing business as
  • Sisters of Mercy of Willard, Ohio Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other BLUEMARK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071009000675 OH Part A Provider - Critical Access Hospital 5395737563 Practice locations: Willard, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790731016. Details of each certification follow.

Hospital certification: CCN 361310

Legal name
MERCY HEALTH - WILLARD HOSPITAL LLC
Doing business as
MERCY HEALTH - WILLARD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 25, 2002
Last certification
Mar 8, 2018
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
LLCNon-profit
Incorporated
Mar 9, 1988 in OH
Enrollment address
1100 Neal Zick Rd
Willard, OH 44890-9287
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Health - Willard HospitalCCN 361310 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Greenwich Medical Ctr3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Dale Thornton Individual Corporate DirectorBoard Member Jan 1, 2022
Gina Skolmowski Individual Corporate DirectorBoard Member Jan 1, 2021
Wendy Huntley Individual Corporate DirectorBoard Member Jan 1, 2021
Mercy Health North LLC Organization, Toledo, OH Non-profit 5% Or Greater Direct Ownership Interest Apr 25, 2002 100%
Timothy Goligoski Individual Corporate DirectorBoard Member Feb 22, 2024
Mark Ridenour Individual Corporate DirectorBoard Member Jan 1, 2021
Wael N Haidar Individual Corporate DirectorBoard Member Jan 1, 2023
Jason Kucsma Individual Corporate DirectorBoard Member Jan 1, 2021
Robert Baxter Individual Corporate DirectorBoard Member Jan 1, 2021
David Zenk Individual Corporate DirectorBoard Member Jan 1, 2021
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Sep 1, 2018 100%
Alexander Garvey Individual Corporate DirectorBoard Member Jan 1, 2025
John Starcher Individual Operational/Managerial ControlCho Admin Feb 1, 2016
Andrew Morgan Individual Corporate OfficerPresident Oct 4, 2022
Corporate DirectorBoard Member Oct 4, 2022
W-2 Managing EmployeePresident Oct 4, 2022
Marvin L Whitfield Individual Corporate DirectorBoard Member Jan 1, 2025
Randall William King Individual Corporate DirectorBoard Member Jan 1, 2022
James Brazeau Individual Corporate DirectorBoard Member Jan 1, 2026
Bridget Deegan-Krause Individual Corporate DirectorBoard Member Jan 1, 2021
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Apr 7, 2005
Thomas E Bush Individual Corporate DirectorBoard Member Jan 1, 2026
Luis Santiago Individual Corporate DirectorBoard Member Jan 1, 2023

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 97

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

View all 97

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 141

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

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1790731016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636547",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636547",
            "telephone_number": "419-964-5000",
            "fax_number": "419-964-5178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 NEAL ZICK ROAD",
            "city": "WILLARD",
            "state": "OH",
            "postal_code": "448909287",
            "telephone_number": "419-964-5000",
            "fax_number": "419-964-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH - WILLARD HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "DETTERMAN",
        "authorized_official_first_name": "BUFFY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-455-7074",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "BLUEMARK",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mercy Health - Willard Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sisters of Mercy of Willard, Ohio",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sisters of Mercy of Willard, Ohio",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Willard, OH

Sources for this page

Verify at the official NPI Registry.