Orrville Hospital Foundation
Organization Active NPI Rural Health Clinic/Center · Dalton, OH
NPI 1972968675 · NPPES record last updated Dec 22, 2015
Key facts
- NPI
- 1972968675
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ORRVILLE HOSPITAL FOUNDATION
- Practice address
- 129 Wenger Rd N
Dalton, OH 44618-9056 - Phone
- (330) 684-5480
- Fax
- (330) 828-0094
- NPI assigned
- Dec 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Matthew Stewart
- Title
- Cfo
- Phone
- (330) 684-4763
Owners & managing parties with NPI records 1
-
Andrew J Naumoff, MD
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Facilities with the same owner 14
Practitioners 78
-
Sayeda M Akbar, MSN, APRN, FNP-C
-
Mathew Armstrong, MSN FNP-BC
-
Sarah J Atkinson, CNP
-
Kelli J Baker, CNP
-
Ryan Baltes, APRN
-
Raffi Bardakjian, MD
-
Nicholas R Bellanco, M.D.
-
Jillian Berkshire, NP-C
-
Katie Mae Brenner, D.O.
-
Emily Brown, DO
-
Brett Buller, D.O.
-
Samantha Clark, MD
-
Lisa M Ditchey, DO
-
Jay Dyer, CRNA
-
Sarah Elizabeth Ensinger, CRNP
-
Allison Ferguson, CNP
-
Roxanne N Fish, CNP
-
Carl R Fry, D.O.
-
Amanda Genet, APRN FNP-C
-
Kaitlyn Gray, PA-C
-
Stephen Grossi, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0964222 | Aultman Orrville Dunlap Family | Certificate of waiver | Feb 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Rural health clinic certification: CCN 363406
- Legal name
- ORRVILLE HOSPITAL FOUNDATION
- Doing business as
- AULTMAN ORRVILLE DUNLAP FAMILY PHYSICIANS
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 6, 2016
- Last certification
- Sep 6, 2016
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 17, 1945 in OH
- Enrollment address
- 129 Wenger Rd N
Dalton, OH 44618-9056 - Related CCNs
- 361323
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Auble |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Thomas S Gregory |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Becky Jewell |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Jeffrey B Miller |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Beth Theibert |
W-2 Managing Employee |
Dec 5, 1985 | 100% |
| Alfred Schiaback |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Douglas Sibila |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Ryan S Jones |
Corporate Officer |
Aug 1, 2017 | 7.69% |
| Corporate Director |
Aug 1, 2017 | 7.69% | |
| Edward Roth |
Corporate Officer |
Jan 1, 2012 | 7.69% |
| Aultman Health Foundation |
5% Or Greater Direct Ownership Interest | Jan 1, 2016 | 100% |
| Paul J Crowley |
Corporate Director |
Jan 1, 2016 | 7.69% |
| Diane Jarrett |
Corporate Director |
Jan 28, 2016 | 7.69% |
| George Lemon |
Corporate Director |
Jan 1, 2012 | 7.69% |
| Andrew J Naumoff |
Corporate Officer |
Jan 1, 2014 | 7.69% |
| Adam Luntz |
Corporate Officer |
Apr 1, 2016 | 7.69% |
| Operational/Managerial Control |
Apr 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160301000169 | OH | Part a Provider - Rural Health Clinic | 7911890546 | Practice locations: Dalton, OH |
National Provider Directory
- Tax ID family
- Orrville Hospital Foundation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
129 Wenger Rd N
Dalton, OH 44618-9056
Mailing address
129 Wenger Rd N
Dalton, OH 44618-9056
Phone (330) 684-5480
Other names
- Dunlap Family Physicians
Other providers in Dalton, OH
- Jonesys Lawn Care, Inc
- Connie Kandel
- Kari Ann Lawson
- Steven D Murray
- Peyton Michele Nussbaum
- Kimberly Sue Pizzino
- Provide a Care Inc
- Provide a Care Inc
- Myriam Danielle Jeanne Rabaste
- Kelsey Rowley
All providers in Dalton, OH · Rural Health Clinic/Center in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.