NPIMap

Organization Active NPI

Boone Memorial Hospital, Inc

Doing business as BMH Medical Clinic

  • Rural Health Clinic/Center
  • Madison, WV
National Provider Identifier
1801039565
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
119 Issued in WV
Legal business name
BOONE MEMORIAL HOSPITAL, INC
Doing business as
BMH Medical Clinic
Practice address
660A S Main St
Madison, WV 25130-1245
Phone
(304) 369-4250
Fax
(304) 369-8008
NPI assigned
Apr 10, 2009
Last updated
Jul 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Authorized official

Name
Virgil Underwood
Title
Ceo
Phone
(304) 369-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 119 WV Primary

Addresses

Primary practice location

660A S Main St
Madison, WV 25130-1245

Mailing address

701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230

Other practice location 1

701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230 ext. 204

Other identifiers 1

IdentifierTypeStateIssuer
3810015736MedicaidWV

Other names 1

  • BMH Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051111000050 WV Part B Supplier - Clinic/Group Practice 3375433352 Receives reassigned benefits from 166 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Madison, WV
O20090421000101 WV Part A Provider - Rural Health Clinic 3375433352 Practice locations: Madison, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801039565. Details of each certification follow.

Rural health clinic certification: CCN 513411

Legal name
BOONE MEMORIAL HOSPITAL INC
Doing business as
BMH MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 2009
Last certification
Jun 21, 2023
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2012 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 2010 in WV
Enrollment address
660 South Main Street
Madison, WV 25130-1245
Related CCNs
511313

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

Other NPIs with the same Medicare PAC ID 7

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.

National Provider Directory

National Provider Directory

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Locations

660 S Main St
Madison, WV 25130
Phone (304) 369-4250

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Douglas Cole Malcolm Individual Corporate DirectorCfo Oct 3, 2022
W-2 Managing EmployeeCfo Oct 3, 2022
Boone Memorial Hospital Inc Organization, Madison, WV Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2012 100%
Virgil L Underwood Individual Corporate DirectorBoard Member Jul 1, 2012
W-2 Managing EmployeeCeo Feb 2, 2015 100%

Owners & managing parties with NPI records 7

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
Boone Memorial Hospital IncMadison, WV, CCN 511313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
Boone Memorial HospitalMadison, WV, CCN 51Z313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Family Medical CenterMadison, WV, CCN 513992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Comfort ClinicComfort, WV, CCN 513433 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 25, 2022
Aug 28, 2022

Owned or controlled facilities with NPI records 4

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 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1801039565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301669",
            "telephone_number": "304-369-1230",
            "fax_number": "304-369-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660A S MAIN ST",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301245",
            "telephone_number": "304-369-4250",
            "fax_number": "304-369-8008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WV",
            "postal_code": "251301669",
            "country_code": "US",
            "telephone_number": "304-369-1230 x204",
            "fax_number": "304-369-6036",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BOONE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-10",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "UNDERWOOD",
        "authorized_official_first_name": "VIRGIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-369-1230"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WV",
            "license": "119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810015736",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BMH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WV

Sources for this page

Verify at the official NPI Registry.