NPIMap

Organization Active NPI

Boone Memorial Hospital Inc

Doing business as Boone Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Madison, WV
National Provider Identifier
1871543322
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
119 Issued in WV
Legal business name
BOONE MEMORIAL HOSPITAL INC
Doing business as
Boone Memorial Hospital
Practice address
701 Madison Ave
Madison, WV 25130-1669
Phone
(304) 369-1230
Fax
(304) 369-6036
NPI assigned
May 12, 2006
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Douglas Cole Malcolm
Title
Cfo
Phone
(304) 369-1230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 119 WV Primary

Addresses

Primary practice location

701 Madison Ave
Madison, WV 25130-1669

Mailing address

701 Madison Ave
Madison, WV 25130-1669
Phone (304) 369-1230

Other names 1

  • BOONE 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
O20061104000274 WV Part A Provider - Critical Access Hospital 3375433352 Practice locations: Madison, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871543322. Details of each certification follow.

Hospital certification: CCN 51Z313

Legal name
BOONE MEMORIAL HOSPITAL INC
Doing business as
BOONE MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 2012 in WV
Enrollment address
701 Madison Ave
Madison, WV 25130-1669
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Boone Memorial Hospital Home Care HMKR11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Douglas Cole Malcolm Individual W-2 Managing EmployeeAd;Cfo Oct 3, 2022 100%
Boone Memorial Hospital Inc Organization, Madison, WV Created for acquisition, Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2012 100%
Virgil L Underwood Individual Corporate DirectorBoard Member Jul 1, 2012
W-2 Managing EmployeeCeo Feb 2, 2015 100%

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Boone Memorial Hospital IncMadison, WV, CCN 511313 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Family Medical CenterMadison, WV, CCN 513992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Medical ClinicMadison, WV, CCN 513411 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Comfort ClinicComfort, WV, CCN 513433 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 25, 2022
Aug 28, 2022

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1871543322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301669",
            "telephone_number": "304-369-1230",
            "fax_number": "304-369-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MADISON AVE",
            "city": "MADISON",
            "state": "WV",
            "postal_code": "251301669",
            "telephone_number": "304-369-1230",
            "fax_number": "304-369-6036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "MALCOLM",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-369-1230"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WV",
            "license": "119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOONE MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BOONE MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WV

Sources for this page

Verify at the official NPI Registry.