NPIMap

Organization Active NPI

Camden on Gauley Medical Center Inc

Doing business as Camden Family Health

  • Federally Qualified Health Center (FQHC)
  • Ansted, WV
National Provider Identifier
1801493499
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
Camden Family Health
Practice address
101 Florence St
Ansted, WV 25812-5200
Phone
(304) 226-5725
Fax
(304) 226-3274
NPI assigned
Oct 6, 2020
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Shanna Strader
Title
HR Manager/Credentialing
Phone
(304) 226-5725

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

101 Florence St
Ansted, WV 25812-5200

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 226-5725

Other names 1

  • Camden Family Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201124003203 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Ansted, WV
O20230629001639 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 32 practitioners
Practice locations: Ansted, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801493499. Details of each certification follow.

Federally qualified health center certification: CCN 581803

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2020
Last certification
Oct 20, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1979 in WV
Enrollment address
101 Florence St
Ansted, WV 25812-5200

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory

Locations

16 W Main St
Richwood, WV 26261
Phone (304) 846-0207

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Roy Moose Individual Corporate Director Jan 1, 2010
Elizabeth Snyder Individual Corporate Director Jan 1, 1997
David Martin Individual Corporate Director Jan 1, 1989
Sharon Hanna Individual Corporate Director Jan 1, 1981
Margaret Hickey Individual Corporate Officer Mar 1, 2011
James Gamble Individual Corporate Director Jan 1, 1989
Melissa Rogers Individual W-2 Managing Employee Mar 24, 2014

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Camden Family HealthCraigsville, WV, CCN 511091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center IncSummersville, WV, CCN 511145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1801493499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FLORENCE ST",
            "city": "ANSTED",
            "state": "WV",
            "postal_code": "258125200",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "STRADER",
        "authorized_official_first_name": "SHANNA",
        "authorized_official_title_or_position": "HR MANAGER/CREDENTIALING",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ansted, WV

Sources for this page

Verify at the official NPI Registry.