NPIMap

Organization Active NPI

Camden on Gauley Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Summersville, WV
National Provider Identifier
1952033508
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CAMDEN ON GAULEY MEDICAL CENTER INC
Practice address
651 Water St
Summersville, WV 26651-1454
Phone
(304) 872-5678
Fax
(304) 226-3274
NPI assigned
Jun 30, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Authorized official

Name
Shanna Strader
Title
HR
Phone
(304) 226-5725

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

651 Water St
Summersville, WV 26651-1454

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 226-5725

Other names 1

  • Camden Family Vision Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220912001968 WV Part B Supplier - Clinic/Group Practice 6002867850 Receives reassigned benefits from 1 practitioner
Practice locations: Summersville, WV
O20221018001592 WV Part A Provider - Federally Qualified Health Center (FQHC) 6002867850 Practice locations: Summersville, WV

Federally qualified health center certification: CCN 581843

Legal name
CAMDEN ON GAULEY MEDICAL CENTER INC
Doing business as
CAMDEN FAMILY VISION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 18, 2022
Last certification
Oct 18, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1979 in WV
Enrollment address
651 Water St
Summersville, WV 26651-1454

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Camden on Gauley Medical Center Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

10003 Webster Rd
Camden on Gly, WV 26208
Phone (304) 266-5725

651 Water St
Summersville, WV 26651
Phone (304) 872-5678

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Roy Moose Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 2010 100%
Elizabeth Snyder Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 1997 100%
Barbara Butler Individual 5% Or Greater Indirect Ownership InterestBoard Member Nov 18, 2019 100%
Sharon Hanna Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 1981
Margaret Hickey Individual Corporate OfficerCeo Mar 1, 2011 100%
James Gamble Individual 5% Or Greater Indirect Ownership InterestBoard Member Jan 1, 1989 100%
Melissa Rogers Individual W-2 Managing Employee Mar 25, 2014
Tiffany Montgomery Individual 5% Or Greater Indirect Ownership Interest Mar 22, 2021 100%
Jane Sherwood Individual 5% Or Greater Indirect Ownership InterestBoard Member Aug 1, 2020

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Camden Family HealthCraigsville, WV, CCN 511091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979
Camden on Gauley Medical Center IncSummersville, WV, CCN 511145 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1979

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 44

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

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1952033508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 WATER ST",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511454",
            "telephone_number": "304-872-5678",
            "fax_number": "304-226-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMDEN ON GAULEY MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-30",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "STRADER",
        "authorized_official_first_name": "SHANNA",
        "authorized_official_title_or_position": "HR",
        "authorized_official_telephone_number": "304-226-5725"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camden Family Vision",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camden Family Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Summersville, WV

Sources for this page

Verify at the official NPI Registry.