NPIMap

Organization Active NPI

Jefferson Memorial Hospital

Doing business as Jefferson Medical Center

  • Critical Access Hospital
  • Ranson, WV
National Provider Identifier
1891722377
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
103 Issued in WV
Legal business name
JEFFERSON MEMORIAL HOSPITAL
Doing business as
Jefferson Medical Center
Practice address
300 S. Preston Street
Ranson, WV 25438-1631
Phone
(304) 728-1600
Fax
(304) 725-9492
NPI assigned
Jun 28, 2006
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST VIRGINIA UNIVERSITY HOSPITALS EAST INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Kathleen R Quinones
Title
Interim VP Finance
Phone
(304) 260-1443

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 103 WV Primary

Addresses

Primary practice location

300 S. Preston Street
Ranson, WV 25438-1631

Mailing address

PO Box 1170
Morgantown, WV 26507-1170
Phone (304) 598-6795

Other names 1

  • Jefferson Medical Center Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com Other
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000736 WV Part B Supplier - Clinic/Group Practice 0446151989 Receives reassigned benefits from 116 practitioners
2 other NPIs on this enrollment
Practice locations: Ranson, WV
O20230202001687 WV Part A Provider - Critical Access Hospital 0446151989 Receives reassigned benefits from 115 practitioners
3 other NPIs on this enrollment
Practice locations: Ranson, WV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891722377. Details of each certification follow.

Hospital certification: CCN 511319

Legal name
JEFFERSON MEMORIAL HOSPITAL
Doing business as
JEFFERSON MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 15, 2005
Last certification
Jan 31, 2018
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 26, 1912 in WV
Enrollment address
300 S Preston St
Ranson, WV 25438-1631
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Jefferson Medical CenterCCN 511319 · All quality measures
Overall star rating
1 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Brian Romine Individual Corporate Director Jan 1, 2017
Albert Wright Individual Corporate Director Feb 1, 2022
Susan Snowden Individual Corporate Director Feb 4, 2019
Dean Thomas Individual W-2 Managing EmployeePres / Ceo Jan 1, 2021
Chiquita Howard-Bostic Individual Corporate Director Aug 1, 2015
Deborah Burge Individual W-2 Managing Employee Jun 1, 2021
Alice Frazier Individual Corporate Director Feb 4, 2019
West Virginia University Hospitals East Inc Organization, Martinsburg, WV Non-profit Operational/Managerial Control Jan 1, 2005
James Rogers Individual Corporate Director Apr 2, 2018
Dawn R Jones Individual Corporate Director May 26, 2015
Jackee Long Individual Corporate Director Jan 1, 2012
Grover Zach Kerns Individual W-2 Managing EmployeeVP of Fin Jan 25, 2019
West Virginia United Health System, Inc Organization, Fairmont, WV Non-profit Operational/Managerial Control Jan 1, 2005
Michael S Londner Individual Corporate Director Jan 1, 2021
Marney B Treese Individual Corporate Director Feb 4, 2019
Douglas Scott Roach Individual Corporate OfficerTreasurer Jan 1, 2011
Henry Kayes Individual Corporate DirectorBoard of Dir Jan 1, 2017
Emma Morton-Eggleston Individual Corporate Director Jan 1, 2017
Michael Edmond Individual Corporate Director Jan 1, 2021

Owners & managing parties with NPI records 5

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

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 160

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 160

Affiliated clinicians 337

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

View all 337

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1891722377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1170",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265071170",
            "telephone_number": "304-598-6795",
            "fax_number": "304-598-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S. PRESTON STREET",
            "city": "RANSON",
            "state": "WV",
            "postal_code": "254381631",
            "telephone_number": "304-728-1600",
            "fax_number": "304-725-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST VIRGINIA UNIVERSITY HOSPITALS EAST INC",
        "enumeration_date": "2006-06-28",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "QUINONES",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "INTERIM VP FINANCE",
        "authorized_official_telephone_number": "304-260-1443"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WV",
            "license": "103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Parkway",
            "address_2": "Suite 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "21044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Jefferson Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jefferson Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ranson, WV

Sources for this page

Verify at the official NPI Registry.