NPIMap

Organization Active NPI

Adams County Regional Medical Center

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

  • Rural Health Clinic/Center
  • Mount Orab, OH
National Provider Identifier
1942974332
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ADAMS COUNTY REGIONAL MEDICAL CENTER
Doing business as
Adams County Regional Medical Center (ACRMC) Family Medicine
Practice address
217 Hughes Boulevard
Mount Orab, OH 45154
Phone
(937) 346-8826
NPI assigned
Aug 9, 2021
Last updated
Aug 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

217 Hughes Boulevard
Mount Orab, OH 45154

Mailing address

217 Hughes Boulevard
Mount Orab, OH 45154

Other names 1

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942974332. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 1, 2019 in OH
Enrollment address
217 Hughes Blvd
Mount Orab, OH 45154-8356
Related CCNs
361326

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

Other NPIs with the same Medicare PAC ID 6

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2233302Acrmc Family Medicine217 Hughes Boulevard, Mount Orab, OH 45154Certificate of waiverAug 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Adams County Regional Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

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 OfficerCfo Oct 1, 2019
Matthew a Armstrong Individual Corporate DirectorBoard Member Oct 1, 2019
Radah Curtis Individual W-2 Managing EmployeeRevenue Cycle Manager Oct 1, 2019
Alan Bird Individual Corporate OfficerCeo Oct 1, 2019
Dane R Clark Individual Corporate DirectorBoard Member Oct 1, 2019
Peggy Chalker Individual Corporate DirectorBoard Member Oct 1, 2019
Jack a McCoy Individual Corporate DirectorBoard Member Oct 1, 2019
Sherri M Spencer Individual Corporate DirectorBoard Member Oct 1, 2019
Chad Wilson Individual Corporate DirectorBoard Member Oct 1, 2019
Roy Gustin Individual Corporate DirectorBoard Member Oct 1, 2019

Owners & managing parties with NPI records 1

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

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 MedicineWinchester, OH, CCN 363431 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2019

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628467200000",
    "number": "1942974332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 HUGHES BOULEVARD",
            "city": "MOUNT ORAB",
            "state": "OH",
            "postal_code": "45154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 HUGHES BOULEVARD",
            "city": "MOUNT ORAB",
            "state": "OH",
            "postal_code": "45154",
            "telephone_number": "937-346-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADAMS COUNTY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-09",
        "last_updated": "2021-08-09",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "DAGENBACH",
        "authorized_official_first_name": "PETE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "937-386-3007"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adams County Regional Medical Center (ACRMC) Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Orab, OH

Sources for this page

Verify at the official NPI Registry.