NPIMap

Organization Active NPI

Camden on Gauley Medical Center Inc

Doing business as Camden Family Health (lewis)

  • Federally Qualified Health Center (FQHC)
  • Weston, WV
National Provider Identifier
1861872541
Registry record updated Dec 10, 2021
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 (lewis)
Practice address
300 Minuteman Drive
Weston, WV 26452-1736
Phone
(304) 997-8701
Fax
(304) 997-8735
NPI assigned
Jun 8, 2015
Last updated
Dec 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Authorized official

Name
Margaret Hickey
Title
Ceo
Phone
(304) 226-5725

Specialties & licenses 1

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

Addresses

Primary practice location

300 Minuteman Drive
Weston, WV 26452-1736

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1861872541MedicaidWV

Other names 1

  • Camden Family Health (lewis) Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20151019001489 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Weston, WV
O20160125000001 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 17 practitioners
Practice locations: Weston, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861872541. Details of each certification follow.

Federally qualified health center certification: CCN 511076

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 25, 2015
Last certification
Aug 25, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 30, 1979 in WV
Enrollment address
300 Minuteman Dr
Weston, WV 26452-2200

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

Ownership & related parties

All disclosed owners & managing parties 10

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 DirectorBoard Member Jan 1, 2010
Elizabeth Snyder Individual Corporate DirectorBoard Member Jan 1, 1997
Barbara Butler Individual Corporate DirectorBoard Member Nov 18, 2019
Brandon Moll Individual Corporate DirectorBoard Member Aug 12, 2022
Sharon Hanna Individual Corporate DirectorBoard Member Jan 1, 1981
Margaret Hickey Individual Corporate OfficerCeo Mar 1, 2011
W-2 Managing EmployeeCeo Mar 1, 2011
Operational/Managerial ControlCeo Mar 1, 2011
James Gamble Individual Corporate DirectorBoard Member Jan 1, 1989
Melissa Rogers Individual Corporate OfficerCoo Mar 4, 2014
W-2 Managing EmployeeCoo Aug 13, 2015
Tiffany Montgomery Individual Corporate DirectorBoard Member Mar 22, 2021
Jane Sherwood Individual Corporate DirectorBoard Member Aug 1, 2020

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 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1861872541",
    "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",
            "fax_number": "304-226-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MINUTEMAN DRIVE",
            "city": "WESTON",
            "state": "WV",
            "postal_code": "264521736",
            "telephone_number": "304-997-8701",
            "fax_number": "304-997-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861872541",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Health (lewis)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Health (lewis)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weston, WV

Sources for this page

Verify at the official NPI Registry.