NPIMap

Organization Active NPI

Memorial Hospital

  • General Acute Care Hospital
  • Fremont, OH
National Provider Identifier
1851338149
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
MEMORIAL HOSPITAL
Practice address
715 South Taft Avenue
Fremont, OH 43420-3200
Phone
(419) 332-7321
Fax
(419) 332-5875
NPI assigned
Jun 2, 2006
Last updated
Dec 22, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Authorized official

Name
Mr. Kevin Sharp
Title
VP Rev Cycle
Phone
(567) 585-7576

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU
General Acute Care Hospital 282N00000X OH Primary

Addresses

Primary practice location

715 South Taft Avenue
Fremont, OH 43420-3200

Mailing address

715 South Taft Avenue
Fremont, OH 43420-3200
Phone (419) 332-7321

Other identifiers 2

IdentifierTypeStateIssuer
000000157568OtherOHANTHEM BLUE CROSS BLUE SH
5874728MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000279 OH Part B Supplier - Clinic/Group Practice 9739078528 Receives reassigned benefits from 12 practitioners
Practice locations: Fremont, OH
O20051004000249 OH Part A Provider - Hospital 9739078528 Practice locations: Clyde, OH; Gibsonburg, OH; Fremont, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851338149. Details of each certification follow.

Hospital certification: CCN 360156

Legal name
MEMORIAL HOSPITAL
Doing business as
MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 11, 2023
Beds
179
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Nov 12, 1915 in OH
Enrollment address
715 S Taft Ave
Fremont, OH 43420-3237
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HospitalCCN 360156 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member organizations 6

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

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Terrence G Metzger Individual Corporate OfficerCfo May 14, 2023
Kristie Bilger Individual Corporate DirectorBoard Member Jan 22, 2019
Deana L Sievert Individual Corporate DirectorBoard Member Feb 1, 2022
Kevin Sharp Individual Corporate OfficerVP Rev Cycle Mar 15, 2019
Julie Chudzinski Individual Corporate DirectorBoard Member Feb 11, 2021
Robert Gross Individual Corporate DirectorBoard Member Feb 11, 2021
Paul Hershey Individual Corporate DirectorBoard Member Feb 11, 2021
Christina Stansfield Individual Operational/Managerial ControlDirector Rev Cycle Feb 1, 2020
Pamela Jensen Individual Corporate OfficerPresident Jan 1, 2013
Scott Lang Individual Corporate DirectorBoard Member Feb 6, 2020
Christian Moore Individual Corporate DirectorBoard Member Apr 18, 2019
Kenneth Myers Individual Corporate DirectorChairman of the Board Jan 28, 2014
Dennis Newman Individual Corporate DirectorBoard Member Jan 28, 2014
Bethany S Brown Individual Corporate DirectorBoard Member Jan 22, 2019
Robin Richter Individual Corporate DirectorBoard Member Jan 22, 2019
Diana Eichenauer Individual W-2 Managing EmployeeManager Rev Cycle Jan 1, 2020
Michael E Grillis Individual Corporate DirectorBoard Member Jan 22, 2019
Regina Vincent-Williams Individual Corporate DirectorBoard Member Jan 22, 2019
Amy Anway Individual Corporate DirectorBoard Member Jan 22, 2019
Arturo Polizzi Individual Corporate OfficerCeo May 24, 2022
Memorial Hospital Organization, Fremont, OH Non-profit Operational/Managerial Control Sep 30, 2007
Promedica Health System Inc Organization, Toledo, OH Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Dasa Dzierwa Individual Corporate DirectorBoard Member Feb 1, 2022

Owners & managing parties with NPI records 1

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

Facilities with the same owner 15

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

View all 15

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

Affiliated clinicians 448

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

View all 448

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703203200000",
    "number": "1851338149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 SOUTH TAFT AVENUE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203200",
            "telephone_number": "419-332-7321",
            "fax_number": "419-332-5875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 SOUTH TAFT AVENUE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434203200",
            "telephone_number": "419-332-7321",
            "fax_number": "419-332-5875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A",
        "authorized_official_last_name": "SHARP",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REV CYCLE",
        "authorized_official_telephone_number": "567-585-7576",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SH",
            "identifier": "000000157568",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5874728",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, OH

Sources for this page

Verify at the official NPI Registry.