NPIMap

Adams County Regional Medical Center

Organization Active NPI Rural Health Clinic/Center · Mount Orab, OH

NPI 1942974332 · NPPES record last updated Aug 9, 2021

Key facts

NPI
1942974332
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Practice address
217 Hughes Boulevard
Mount Orab, OH 45154
Phone
(937) 346-8826
NPI assigned
Aug 9, 2021
Organization subpart
No

Authorized official

Name
Pete Dagenbach
Title
Cfo
Phone
(937) 386-3007

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 6

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

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

Practitioners 34

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

View all 34

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2233302Acrmc Family Medicine
217 Hughes Boulevard, Mount Orab, OH 45154		Certificate of waiverAug 22, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OH

Rural health clinic certification: CCN 363435

Legal name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 22, 2022
Last certification
Jun 22, 2022
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Oct 1, 2019 in OH
Enrollment address
217 Hughes Blvd
Mount Orab, OH 45154-8356
Related CCNs
361326

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
Pete R Dagenbach
Individual 		Corporate Officer
Cfo		 Oct 1, 2019
Matthew a Armstrong
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Radah Curtis
Individual 		W-2 Managing Employee
Revenue Cycle Manager		 Oct 1, 2019
Alan Bird
Individual 		Corporate Officer
Ceo		 Oct 1, 2019
Dane R Clark
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Peggy Chalker
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Jack a McCoy
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Sherri M Spencer
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Chad Wilson
Individual 		Corporate Director
Board Member		 Oct 1, 2019
Roy Gustin
Individual 		Corporate Director
Board Member		 Oct 1, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Acrmc Family Medicine
Winchester, OH · CCN 363431		 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20211115000822 OH Part a Provider - Rural Health Clinic 8921431131 Practice locations: Mount Orab, OH

National Provider Directory

Tax ID family
Adams County Regional Medical Center (7 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

217 Hughes Boulevard
Mount Orab, OH 45154

Mailing address

217 Hughes Boulevard
Mount Orab, OH 45154

Other names

  • Adams County Regional Medical Center (ACRMC) Family Medicine Doing business as

Other providers in Mount Orab, OH

All providers in Mount Orab, OH · Rural Health Clinic/Center in Ohio

Sources for this page

Verify at the official NPI Registry.