NPIMap

Organization Active NPI

Hospital Development Co

  • Rural Health Clinic/Center
  • Left Hand, WV
National Provider Identifier
1790745677
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
74 Issued in WV
Legal business name
HOSPITAL DEVELOPMENT CO
Practice address
1 Library LN
Left Hand, WV 25251-9745
Phone
(304) 927-6819
Fax
(304) 927-6837
NPI assigned
Mar 24, 2006
Organization subpart
Yes
Parent organization
ROANE GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

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

Authorized official

Name
Doug Bentz
Title
Ceo
Phone
(304) 927-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 74 WV Primary

Addresses

Primary practice location

1 Library LN
Left Hand, WV 25251-9745

Mailing address

200 Hospital Dr
Spencer, WV 25276-1050
Phone (304) 927-6819

Other identifiers 1

IdentifierTypeStateIssuer
3810004237MedicaidWV

Other names 1

  • SOUTHERN ROANE MEDICAL CLINIC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040406000528 WV Part B Supplier - Clinic/Group Practice 4183527476 Receives reassigned benefits from 96 practitioners
1 other NPI on this enrollment
Practice locations: Walton, WV; Spencer, WV; Arnoldsburg, WV; Left Hand, WV
O20101112000435 WV Part A Provider - Rural Health Clinic 4183527476 Practice locations: Left Hand, WV

Rural health clinic certification: CCN 513409

Legal name
HOSPITAL DEVELOPMENT CO.
Doing business as
SOUTHERN ROANE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 2005
Last certification
May 26, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 25, 1966 in WV
Enrollment address
1 Library LN 2
Left Hand, WV 25251-9745
Related CCNs
511306

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
51D1034229Southern Roane Medical Clinic1 Library Lane Suite 2, Left Hand, WV 25251Certificate of waiverNov 29, 2026

National Provider Directory

National Provider Directory
Part of
Hospital Development Co

Locations

200 Hospital Dr
#C14493
Spencer, WV 25276

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kevin Gaughan Individual Corporate DirectorDirector Oct 1, 2016
Christine Hedges Individual Corporate Director Feb 28, 2011
John Varda Individual Corporate Director May 27, 1999
Grant Stephen Parkins Individual W-2 Managing EmployeeMedical Director Oct 1, 2014
Hospital Development Co. Organization, Spencer, WV Operational/Managerial Control Sep 25, 2005
Douglas Bentz Individual Corporate DirectorEx Officio: Ceo Oct 9, 2000
W-2 Managing EmployeeCeo Oct 9, 2000
John Taylor Individual Corporate Director Mar 28, 2002
Robert E. Zdanek Individual Corporate Director Jan 26, 2004
Jack Garrett Individual Corporate Director Jun 5, 1995
Jennifer F McCulty Individual Corporate Director May 23, 2005
Gloria Atkinson Individual Corporate Director Sep 24, 2007
William Downey Individual Corporate Director May 24, 2001
Hong-Kin NG Individual Corporate DirectorEx Officio: Chief of Medical Staff Jan 1, 2014
Gregory Boggs Individual Corporate Director Sep 24, 2007
Paul Hughes Individual Corporate Director May 28, 1998

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Roane General HospitalSpencer, WV, CCN 515099 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 27, 1970
Jan 27, 1970
Roane General HospitalWalton, WV, CCN 513417 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 3, 2013
Jun 3, 2013
Hospital Development Co.Spencer, WV, CCN 513408 Rural health clinic Operational/Managerial Control Apr 20, 2004
Arnoldsburg Medical ClinicArnoldsburg, WV, CCN 513436 Rural health clinic 5% Or Greater Direct Ownership Interest Oct 1, 2023

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 103

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289174400000",
    "number": "1790745677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761050",
            "telephone_number": "304-927-6819",
            "fax_number": "304-927-6837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LIBRARY LN",
            "city": "LEFT HAND",
            "state": "WV",
            "postal_code": "252519745",
            "telephone_number": "304-927-6819",
            "fax_number": "304-927-6837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPITAL DEVELOPMENT CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROANE GENERAL HOSPITAL",
        "enumeration_date": "2006-03-24",
        "last_updated": "2010-11-08",
        "status": "A",
        "authorized_official_last_name": "BENTZ",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-927-6200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WV",
            "license": "74",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004237",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN ROANE MEDICAL CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Left Hand, WV

Sources for this page

Verify at the official NPI Registry.