NPIMap

Organization Active NPI

Southern Ohio Medical Center

  • Rehabilitation Hospital Unit
  • Portsmouth, OH
National Provider Identifier
1982635744
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
SOUTHERN OHIO MEDICAL CENTER
Practice address
1805 27TH Street
2ND Floor
Portsmouth, OH 45662
Phone
(740) 356-8560
Fax
(740) 354-6421
NPI assigned
Jul 6, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dean Wray
Title
Vice President of Finance
Phone
(740) 356-8540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary

Addresses

Primary practice location

1805 27TH Street
2ND Floor
Portsmouth, OH 45662

Mailing address

1087 Dennison Ave
4TH Floor West
Columbus, OH 43201-3201
Phone (614) 544-5696

Other identifiers 1

IdentifierTypeStateIssuer
7892571MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071208000190 OH Part A Provider - Hospital 8325043383 Practice locations: Portsmouth, OH; Wheelersburg, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982635744. Details of each certification follow.

Hospital certification: CCN 36T008

Legal name
SOUTHERN OHIO MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Jan 22, 1954 in OH
Enrollment address
8430 Hayport Rd
Wheelersburg, OH 45694-1831
Opt Extension Site
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Southern Ohio Medical CenterCCN 36T008 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1993

National Provider Directory

National Provider Directory
Tax ID family
South Shore Family Prac17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Locations

1805 27th St
Fl 2
Portsmouth, OH 45662
Phone (740) 356-8560

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Elie M Saab Individual Corporate DirectorBoard Member Jan 1, 2014
Gary Duzan Individual Corporate DirectorBoard Member Jul 1, 2006
Robert Dever Individual Corporate DirectorBoard Member Jul 1, 2006
Ben Gill Individual Corporate OfficerCeo Jan 1, 2021
W-2 Managing EmployeeCeo Aug 20, 2010
David Fowler Individual Corporate DirectorBoard Member Jul 1, 2007
Tom Reiser Individual Corporate DirectorBoard Member Jul 1, 2018
George Lawson Individual Corporate DirectorBoard Member Jan 24, 2007
Claudia L Burchett Individual W-2 Managing EmployeeVP of Nursing Jan 1, 2006
Randal Arnett Individual Corporate DirectorDirector Jan 1, 2021
Kara Plummer Individual Corporate OfficerVP Jan 1, 2021
Becky Thiel Individual Corporate DirectorBoard Member Jul 1, 2018
Steven Conley Individual Corporate DirectorBoard Member Jul 1, 2006
Vicki Noel Individual W-2 Managing EmployeeVP of Human Resources Jul 1, 2006
Matthew Miller Individual Corporate DirectorDirector Jan 1, 2021
Jesse P Houghton Individual Corporate OfficerOfficer Jan 1, 2024
Tanya Jana C Escalona Individual Corporate DirectorDirector Jan 1, 2021
Kendall L Stewart Individual Corporate OfficerVP of Medical Affairs Jul 1, 2006
Joseph W Herrmann Individual Corporate DirectorOfficer Jan 1, 2024

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 6

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982635744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1087 DENNISON AVE",
            "address_2": "4TH FLOOR WEST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432013201",
            "telephone_number": "614-544-5696",
            "fax_number": "614-544-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 27TH STREET",
            "address_2": "2ND FLOOR",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "45662",
            "telephone_number": "740-356-8560",
            "fax_number": "740-354-6421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WRAY",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "740-356-8540",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7892571",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, OH

Sources for this page

Verify at the official NPI Registry.