NPIMap

Organization Active NPI

Braxton County Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Gassaway, WV
National Provider Identifier
1861580334
Registry record updated Nov 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
03 Issued in WV
Legal business name
BRAXTON COUNTY MEMORIAL HOSPITAL
Doing business as
Braxton County Memorial Hospital
Practice address
100 Hoylman Dr
Gassaway, WV 26624-9321
Phone
(304) 364-5156
Fax
(304) 364-5809
NPI assigned
Oct 10, 2006
Last updated
Nov 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2018

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

Authorized official

Name
Kimberly Dawn Knight
Title
Cfo
Phone
(304) 364-1128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 03 WV Primary

Addresses

Primary practice location

100 Hoylman Dr
Gassaway, WV 26624-9321

Mailing address

100 Hoylman Dr
Gassaway, WV 26624-9321
Phone (304) 364-5156

Other names 1

  • Braxton County Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220908003440 WV Part A Provider - Critical Access Hospital 5193717759 Practice locations: Gassaway, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861580334. Details of each certification follow.

Hospital certification: CCN 51Z308

Legal name
BRAXTON COUNTY MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
100 Hoylman Dr
Gassaway, WV 26624-9318
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Michael C. Tillman Individual Corporate DirectorBoard Member Jan 1, 2019
Sally Howard Individual Corporate DirectorBoard Member Jul 7, 2007 12.5%
Deborah Burge Individual W-2 Managing EmployeeMGR ENT Patient Fin SVCS Jun 1, 2021
Richard Facemire Individual Corporate DirectorBoard Member Jun 30, 2011 12.5%
West Virginia United Health System, Inc Organization, Morgantown, WV Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2019 100%
Lawrence Boggs Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Louis G Roe Individual Corporate DirectorPresident/Ceo Jul 6, 2021
W-2 Managing EmployeePresident/Ceo Jul 6, 2021
Timothy Sodaro Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Stephanie Lea Frame Individual Corporate DirectorDO Jul 1, 2016
Barbara Adams Individual Corporate DirectorBoard Member Jul 1, 2007 12.5%
Kimberly Knight Individual Corporate OfficerCfo Jan 1, 2014 12.5%
W-2 Managing EmployeeCfo Apr 4, 2014 12.5%

Owners & managing parties with NPI records 1

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
Braxton Community Health CenterGassaway, WV, CCN 513400 Rural health clinic 5% Or Greater Direct Ownership Interest (43%)
5% Or Greater Security Interest (57%)		 Jul 7, 2007
Jul 1, 2007

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 52

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

View all 52

Practitioners & affiliated clinicians

Practitioners 109

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 109

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542672000000",
    "number": "1861580334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOYLMAN DR",
            "city": "GASSAWAY",
            "state": "WV",
            "postal_code": "266249321",
            "telephone_number": "304-364-5156",
            "fax_number": "304-364-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOYLMAN DR",
            "city": "GASSAWAY",
            "state": "WV",
            "postal_code": "266249321",
            "telephone_number": "304-364-5156",
            "fax_number": "304-364-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAXTON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2018-11-20",
        "status": "A",
        "authorized_official_last_name": "KNIGHT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-364-1128"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WV",
            "license": "03",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Braxton County Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Braxton County Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gassaway, WV

Sources for this page

Verify at the official NPI Registry.