Mercy Health - Willard Hospital LLC
Organization Active NPI Critical Access Hospital · Willard, OH
NPI 1790731016 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1790731016
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- MERCY HEALTH - WILLARD HOSPITAL LLC
- Practice address
- 1100 Neal Zick Road
Willard, OH 44890-9287 - Phone
- (419) 964-5000
- Fax
- (419) 964-5178
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Buffy Lynn Detterman
- Title
- Ceo
- Phone
- (419) 455-7074
Owners & managing parties with NPI records 1
-
Randall W King, MD
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 97
Practitioners 2
-
Billy Back, MD
-
Gohar Ghazarian, MD
Affiliated clinicians 141
-
Harith Adnan, MD
-
Ali Ahmad, MD
-
Mark J Akers, M.D.
-
Adnan Al-Khalili, MD
-
Michael L. Amalfitano, D.O.
-
Arlette T Aouad, M.D.
-
Mohamed Ayoubi, M.D.
-
Billy Back, MD
-
Justeen Jo Barth, CNM, WHNP
-
Yohannes Bayissa, M.D.
-
Sarah Beattie, CNP
-
Daniel B Berry, MD
-
Christopher J Bohach, DPM
-
Christopher Paul Boutton, CRNA
-
Tanveer Singh Brar, M.D.
-
Patrick A Breslin, D.O.
-
Steven Bruhl, MD
-
Tammy Lynn Bryant, CNP
-
Mark W Burket, M.D.
-
Aaron Cain, DO
Medicare Care Compare: Hospital
- Listed as
- Mercy Health - Willard Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
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
- LLC · Non-profit
- Incorporated
- Mar 9, 1988 in OH
- Enrollment address
- 1100 Neal Zick Rd
Willard, OH 44890-9287
All disclosed owners & managing parties 21
| Name | Role | Since | Share |
|---|---|---|---|
| Dale Thornton |
Corporate Director |
Jan 1, 2022 | |
| Gina Skolmowski |
Corporate Director |
Jan 1, 2021 | |
| Wendy Huntley |
Corporate Director |
Jan 1, 2021 | |
| Mercy Health North LLC |
5% Or Greater Direct Ownership Interest | Apr 25, 2002 | 100% |
| Timothy Goligoski |
Corporate Director |
Feb 22, 2024 | |
| Mark Ridenour |
Corporate Director |
Jan 1, 2021 | |
| Wael N Haidar |
Corporate Director |
Jan 1, 2023 | |
| Jason Kucsma |
Corporate Director |
Jan 1, 2021 | |
| Robert Baxter |
Corporate Director |
Jan 1, 2021 | |
| David Zenk |
Corporate Director |
Jan 1, 2021 | |
| Bon Secours Mercy Health Inc |
5% Or Greater Indirect Ownership Interest | Sep 1, 2018 | 100% |
| Alexander Garvey |
Corporate Director |
Jan 1, 2025 | |
| John Starcher |
Operational/Managerial Control |
Feb 1, 2016 | |
| Andrew Morgan |
Corporate Officer |
Oct 4, 2022 | |
| Corporate Director |
Oct 4, 2022 | ||
| W-2 Managing Employee |
Oct 4, 2022 | ||
| Marvin L Whitfield |
Corporate Director |
Jan 1, 2025 | |
| Randall William King |
Corporate Director |
Jan 1, 2022 | |
| James Brazeau |
Corporate Director |
Jan 1, 2026 | |
| Bridget Deegan-Krause |
Corporate Director |
Jan 1, 2021 | |
| Kimberly M Ralston |
W-2 Managing Employee |
Apr 7, 2005 | |
| Thomas E Bush |
Corporate Director |
Jan 1, 2026 | |
| Luis Santiago |
Corporate Director |
Jan 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071009000675 | OH | Part a Provider - Critical Access Hospital | 5395737563 | Practice locations: Willard, OH |
National Provider Directory
- Tax ID family
- Mercy Clinics
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000157361 | Other | OH | ANTHEM |
| 9474500 | Medicaid | OH |
Other names
- Mercy Health - Willard Hospital
- Sisters of Mercy of Willard, Ohio
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | BLUEMARK |
Other providers in Willard, OH
- Mercy Health - Willard Hospital LLC
- Mercy Health - Willard Hospital LLC
- Mercy Health - Willard Hospital LLC
- Mercy Health - Willard Hospital LLC
- Mercy Health - Willard Hospital LLC
- Mercy Health System-Northern Region
- Midwest Emergency Services Ohio, Inc
- Vanessa Kaye Montgomery
- Sarra Moore
- Sherri Lynnette Mullins
All providers in Willard, OH · Critical Access Hospital in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. 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.