NPIMap

Organization Active NPI

Carthage Area Hospital, Inc.

Doing business as Lafargeville School Based Health Clinic

  • Rural Health Clinic/Center
  • La Fargeville, NY
National Provider Identifier
1881926533
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARTHAGE AREA HOSPITAL, INC.
Doing business as
Lafargeville School Based Health Clinic
Practice address
20414 Sunset Avenue
Lafargeville, NY 13656-2222
Phone
(315) 493-1000
Fax
(315) 493-0105
NPI assigned
Feb 5, 2010
Last updated
May 5, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CARTHAGE AREA HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Mr. Richard Duvall
Title
Administrator
Phone
(315) 519-5201

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Student Health Clinic/Center 261QS1000X 2238001H NY

Addresses

Primary practice location

20414 Sunset Avenue
Lafargeville, NY 13656-2222

Mailing address

20414 Sunset Avenue
Lafargeville, NY 13656-2222
Phone (315) 493-1000

Other identifiers 2

IdentifierTypeStateIssuer
333987OtherMEDICARE PTAN
05797833MedicaidNY

Other names 1

  • Lafargeville School Based Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181220000153 NY Part A Provider - Rural Health Clinic 9931010485 Practice locations: La Fargeville, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881926533. Details of each certification follow.

Rural health clinic certification: CCN 333987

Legal name
CARTHAGE AREA HOSPITAL INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 26, 2019
Last certification
Jul 15, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1965 in NY
Enrollment address
20414 Sunrise Ave
La Fargeville, NY 13656-2222
Related CCNs
331318

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Carthage Area Hosp32 organizations share this tax ID, including this one
Part of
Carthage Area Hosp

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dale Klock Individual Corporate DirectorVice President of Board May 1, 2010
Andrew R Manzer Individual Corporate OfficerInterim Ceo Mar 2, 2026
W-2 Managing EmployeeAd; Mar 2, 2026
Arnold R Hager Individual Corporate OfficerVP of Revenue Cycle Sep 1, 2025
Jerian O'Dell Individual Corporate OfficerCoo Apr 2, 2023
Mirza M Ashraf Individual Corporate Director May 1, 1992
Tim Sturick Individual Corporate DirectorTreasurer of Board May 1, 2016
Gary Rowe Individual Corporate DirectorPresident of Board May 1, 2007
Larry Hasseler Individual Corporate DirectorSecretary of Board May 1, 2006

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1265328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1881926533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20414 SUNSET AVENUE",
            "city": "LAFARGEVILLE",
            "state": "NY",
            "postal_code": "136562222",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20414 SUNSET AVENUE",
            "city": "LAFARGEVILLE",
            "state": "NY",
            "postal_code": "136562222",
            "telephone_number": "315-493-1000",
            "fax_number": "315-493-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE AREA HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARTHAGE AREA HOSPITAL, INC.",
        "enumeration_date": "2010-02-05",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "DUVALL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "315-519-5201",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NY",
            "license": "2238001H",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "333987",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05797833",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lafargeville School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lafargeville School Based Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Fargeville, NY

Sources for this page

Verify at the official NPI Registry.