NPIMap

Organization Active NPI

Marietta Memorial Hospital of Tyler County Inc

Doing business as Sistersville General Hospital

  • Critical Access Hospital
  • Sistersville, WV
National Provider Identifier
1811595192
Registry record updated Oct 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Doing business as
Sistersville General Hospital
Practice address
314 S Wells St
Sistersville, WV 26175-1098
Phone
(304) 652-2611
NPI assigned
Oct 9, 2020
Last updated
Oct 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2020

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

Authorized official

Name
Paul G Westbrock
Title
VP, Legal Affiars
Phone
(740) 374-1581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

314 S Wells St
Sistersville, WV 26175-1098

Mailing address

Dba Sistersville General Hospital C/O Paul Westbrock
314 S Wells St
Sistersville, WV 26175
Phone (740) 374-1581

Other names 1

  • Sistersville General Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201211002702 WV Part A Provider - Critical Access Hospital 4385055342 Receives reassigned benefits from 49 practitioners
Practice locations: Sistersville, WV
O20210601001753 WV Part B Supplier - Clinic/Group Practice 4385055342 Receives reassigned benefits from 45 practitioners
7 other NPIs on this enrollment
Practice locations: Middlebourne, WV; Saint Marys, WV; Sistersville, WV; Williamstown, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811595192. Details of each certification follow.

Hospital certification: CCN 511304

Legal name
MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC
Doing business as
SISTERSVILLE GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 3, 1996
Last certification
May 15, 2024
Beds
25
Ownership / control type
Private (for profit)
Most recent change of ownership
Oct 1, 2020 (3 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 2020 in WV
Enrollment address
314 S Wells St
Sistersville, WV 26175-1098
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sistersville General HospitalCCN 511304 · All quality measures
Type
Critical Access Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Marietta Memorial Hospital of Tyler County Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
James Barengo Individual Corporate DirectorBoard of Directors Jan 1, 2014
Sheryl Holdren Individual Corporate DirectorBoard of Directors Jan 1, 2017
Terry E Rataiczak Individual Corporate DirectorBoard of Directors Jan 1, 2019
Carol a Schneeberger Individual Corporate DirectorTreasurer Jan 1, 2020
Michael Iaderosa Individual Corporate DirectorBoard of Directors Oct 1, 2002
Victoria McGee Individual W-2 Managing EmployeeProvider Enrollment Supervisor May 1, 2014
Joseph D Cooper Individual Corporate DirectorBoard of Directors Jan 1, 2003
Rebekah Gilden Individual W-2 Managing EmployeeCompliance & Privacy Coordinator Jun 1, 2011
Paul G Westbrock Individual Corporate OfficerCompliance Officer Jun 1, 2000
Colleen Cook Individual Corporate DirectorBoard of Directors Jan 1, 2010
Elizabeth a Helmick Individual Corporate DirectorBoard of Directors Feb 1, 2021
Christopher Alexander Cockerham Individual Corporate DirectorBoard of Directors Jan 1, 2020
Thomas Danford Individual Corporate DirectorSecretary Jan 1, 2005
Matthew Pottmeyer Individual Corporate DirectorBoard of Directors Jan 1, 2024
Hugh Sherman Individual Corporate DirectorBoard of Directors Jan 1, 2024
Michael Archer Individual Corporate DirectorPast Chairperson Jan 1, 2005
Gregg M Emerick Individual Corporate DirectorVice Chairperson Jan 1, 2019
Stephen C Keiser Individual Corporate DirectorChairperson Jan 1, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sistersville General Hospital Swing Bed UnitSistersville, WV, CCN 51Z304 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 59

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 59

Affiliated clinicians 100

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

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602201600000",
    "number": "1811595192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DBA SISTERSVILLE GENERAL HOSPITAL C/O PAUL WESTBROCK",
            "address_2": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "26175",
            "telephone_number": "740-374-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 S WELLS ST",
            "city": "SISTERSVILLE",
            "state": "WV",
            "postal_code": "261751098",
            "telephone_number": "304-652-2611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA MEMORIAL HOSPITAL OF TYLER COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-09",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "WESTBROCK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP, LEGAL AFFIARS",
        "authorized_official_telephone_number": "740-374-1581"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sistersville General Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sistersville, WV

Sources for this page

Verify at the official NPI Registry.