NPIMap

Organization Active NPI

Otterbein St. Marys

  • Skilled Nursing Facility
  • Saint Marys, OH
National Provider Identifier
1801888235
Registry record updated Jan 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1960 Issued in OH
Legal business name
OTTERBEIN ST. MARYS
Practice address
11230 State Route 364
Saint Marys, OH 45885-9534
Phone
(419) 394-2366
Fax
(419) 394-2367
NPI assigned
Aug 22, 2005
Last updated
Jan 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2015

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

Authorized official

Name
Mrs. Rita C Hawkins
Title
Avp Finance/Controller
Phone
(513) 933-5401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1960 OH Primary

Addresses

Primary practice location

11230 State Route 364
Saint Marys, OH 45885-9534

Mailing address

11230 State Route 364
Saint Marys, OH 45885-9534
Phone (419) 394-2366

Other identifiers 2

IdentifierTypeStateIssuer
4488260001OtherDMERC
0966012MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021113000002 OH Part A Provider - Skilled Nursing Facility 8921916354 Practice locations: Saint Marys, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801888235. Details of each certification follow.

Skilled nursing facility certification: CCN 365953

Legal name
OTTERBEIN ST MARYS
Doing business as
OTTERBEIN ST MARYS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 9, 1994
Last certification
Sep 14, 2023
Beds
53
Ownership / control type
Corporation
Multi-facility organization
Otterbein SeniorLife
Organization structure
CorporationNon-profit
Incorporated
Feb 21, 2001 in OH
Enrollment address
11230 State Route 364
Saint Marys, OH 45885-9534
Nursing home name
OTTERBEIN ST MARYS RETIREMENT COMMUNITY
Affiliated entity
OTTERBEIN SENIORLIFE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein St Marys Retirement CommunityCCN 365953 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 9, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5349.7 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Otterbein St Marys2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Becky Bayliff Individual Operational/Managerial Control Dec 1, 2021
Steve Dues Individual Managing Control - Governing BodyBoard Member Jan 1, 2013
Trustee of the SNF Jan 1, 2013
Otterbein LSC LLC Organization, Lebanon, OH LLC, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%
Polaris Pharmacy Services of Ohio LLC Organization, Columbus, OH LLC, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Dec 1, 2018
Dave Voisard Individual Managing Control - Governing BodyBoard Member Jan 1, 2021
Trustee of the SNF Jan 1, 2021
John Medaugh Individual Corporate DirectorBoard Member Jan 1, 2020
Operational/Managerial Control Jan 1, 2020
Heidi Glosser Individual Operational/Managerial Control Dec 1, 2021
Victoria Bartlett Individual Operational/Managerial Control Dec 1, 2021
Daniel Young Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Trustee of the SNF Jan 1, 2025
William Brownson Individual Operational/Managerial Control Dec 1, 2021
Jeffrey Ingraham Individual Managing Control - Governing BodyBoard Member Jan 1, 2024
Trustee of the SNF Jan 1, 2024
Rita C Hawkins Individual Operational/Managerial ControlAvp Finance Jan 16, 2006
Tomas Hazelbaker Individual Operational/Managerial Control Dec 1, 2021
Ralph Reed Fraley Individual Operational/Managerial Control Dec 1, 2021
Functional Pathways of Tennessee LLC Organization, Knoxville, TN LLC, Medical provider/supplier, Medical staffing company, For-profit Operational/Managerial Control Dec 1, 2018
Adp of the SNF Apr 4, 2025
Bruce Slavik Individual Corporate DirectorBoard Member Jan 1, 2017
Operational/Managerial Control Jan 1, 2017
Charles R Gamble Individual Managing Control - Governing BodyBoard Member Jul 1, 2014
Trustee of the SNF Jul 1, 2014
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009
Jane Steinemann Individual Managing Control - Governing BodyBoard Member Dec 1, 2021
Trustee of the SNF Dec 1, 2021
Gordon Coffin Individual Managing Control - Governing BodyBoard Member Jan 1, 2023
Trustee of the SNF Jan 1, 2023
Otterbein Home Organization, Lebanon, OH Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 1, 2021 100%
Operational/Managerial Control Dec 1, 2021
Adp of the SNF Dec 1, 2021
James Christopher Green Individual Corporate OfficerVP Finance/Cfo/Treasurer Nov 21, 2005
Operational/Managerial Control Dec 1, 2021
Tara Sibert Individual Operational/Managerial Control Sep 10, 2024
Adp of the SNF Sep 10, 2024
Robert Coleman Individual Operational/Managerial Control Dec 1, 2021
Karen Imwalle Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Trustee of the SNF Jan 1, 2025
Deborah Borns Individual Managing Control - Governing BodyBoard Member Jan 1, 2017
Trustee of the SNF Jan 1, 2017
Rachel Lynn Hunter Individual Operational/Managerial Control Oct 1, 2018
Adp of the SNF Dec 1, 2021
Daniel Burke Individual Operational/Managerial Control Dec 1, 2021
Tyler Kroeger Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Trustee of the SNF Jan 1, 2025
Lynn App Individual Operational/Managerial Control Dec 1, 2021
Steve Vonderhaar Individual Corporate DirectorBoard Member Jan 1, 2020
Operational/Managerial Control Dec 1, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 26

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

View all 26

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1801888235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 STATE ROUTE 364",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458859534",
            "telephone_number": "419-394-2366",
            "fax_number": "419-394-2367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11230 STATE ROUTE 364",
            "city": "SAINT MARYS",
            "state": "OH",
            "postal_code": "458859534",
            "telephone_number": "419-394-2366",
            "fax_number": "419-394-2367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN ST. MARYS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-22",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "RITA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "AVP FINANCE/CONTROLLER",
        "authorized_official_telephone_number": "513-933-5401",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4488260001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0966012",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Marys, OH

Sources for this page

Verify at the official NPI Registry.