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Boone Memorial Hospital Inc

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Madison, WV

NPI 1871543322 · NPPES record last updated Dec 7, 2023

Key facts

NPI
1871543322
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
119 (WV)
Legal business name
BOONE MEMORIAL HOSPITAL INC
Practice address
701 Madison Ave
Madison, WV 25130-1669
Phone
(304) 369-1230
Fax
(304) 369-6036
NPI assigned
May 12, 2006
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 7

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

Owned or controlled facilities with NPI records 4

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 10

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

Member organizations 4

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

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

Facilities with the same owner 4

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

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 78

Affiliated clinicians 3

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WV

Hospital certification: CCN 51Z313

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

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 Employee
Ad;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 Director
Board Member		 Jul 1, 2012
W-2 Managing Employee
Ceo		 Feb 2, 2015 100%

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 Inc
Madison, WV · CCN 511313		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Family Medical Center
Madison, WV · CCN 513992		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Medical Clinic
Madison, WV · CCN 513411		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2012
BMH Comfort Clinic
Comfort, WV · CCN 513433		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 25, 2022
Aug 28, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20061104000274 WV Part a Provider - Critical Access Hospital 3375433352 Practice locations: Madison, WV

National Provider Directory

Tax ID family
Boone County Hospital (11 organizations share this tax ID)

Specialties & licenses

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

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

  • BOONE MEMORIAL HOSPITAL Doing business as

Other providers in Madison, WV

All providers in Madison, WV · Medicare Defined Swing Bed Hospital Unit in West Virginia

Sources for this page

Verify at the official NPI Registry.