NPIMap

Organization Active NPI

Civista Medical Center Inc

  • Rural Acute Care Hospital
  • La Plata, MD
National Provider Identifier
1992701825
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
CIVISTA MEDICAL CENTER INC
Practice address
5 Garrett Avenue
La Plata, MD 20646-1070
Phone
(301) 609-4474
Fax
(301) 609-4411
NPI assigned
Jun 24, 2005
Last updated
Sep 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Authorized official

Name
Albert Zanger
Title
Chief Financial Officer
Phone
(301) 609-5163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X MD Primary

Addresses

Primary practice location

5 Garrett Avenue
La Plata, MD 20646-1070

Mailing address

PO Box 1070
La Plata, MD 20646-1070
Phone (301) 609-5163

Other identifiers 1

IdentifierTypeStateIssuer
003355200MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302000207 MD Part B Supplier - Clinic/Group Practice 7618864976 Receives reassigned benefits from 38 practitioners
1 other NPI on this enrollment
Practice locations: La Plata, MD
O20080115000773 MD Part A Provider - Hospital 7618864976 1 other NPI on this enrollment
Practice locations: La Plata, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992701825. Details of each certification follow.

Hospital certification: CCN 210035

Legal name
CIVISTA MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 1, 2011
Beds
131 (121 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationProprietary
Incorporated
Sep 16, 1938 in MD
Enrollment address
5 Garrett Avenue
La Plata, MD 20646-1070
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
University of MD Charles Regional Medical CenterCCN 210035 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 2

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

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Diane Hicks Individual Corporate Director Aug 27, 2021
Crystal N Hunt Individual Corporate Director Jul 1, 2022
Thomas B Smyth Individual Corporate Officer Jan 26, 2026
Corporate Director Jan 26, 2026
Albert James Zanger Individual Corporate OfficerAo Mar 4, 2019
W-2 Managing Employee Mar 4, 2019
Tamara Saunaitis Individual Corporate Officer Jan 27, 2025
Corporate Director Jan 27, 2025
Kimberly Rosenfield Individual Corporate Officer Jul 1, 2025
Corporate Director Jul 1, 2025
Brianna Bowling Individual Corporate Director Oct 1, 2015
Mary Lilly Individual Corporate Director Jul 1, 2018
Heather Little Individual Corporate DirectorDelegated Official Jan 1, 2021
Barry Wood Individual Corporate Officer Jan 27, 2025
Corporate Director Jan 27, 2025
University of Maryland Medical System Corporation Organization, Baltimore, MD Non-profit 5% Or Greater Indirect Ownership Interest Jun 27, 2011 100%
Other Jun 27, 2011
Ivelisse Michel Individual Corporate Director Jan 1, 2021
Patrick Pierce Individual Corporate Director Jul 1, 2018
Civista Medical Center Inc Organization, La Plata, MD Operational/Managerial Control Nov 20, 2007
Civista Care Partners, Inc Organization, La Plata, MD Non-profit 5% Or Greater Direct Ownership Interest Jun 26, 1998 100%
Maxwell I Ginsburg Individual Corporate Director Jul 1, 2023
Christopher Simpson Individual Corporate Director Jul 1, 2023
Thomas Dennison Individual Corporate Director Jul 1, 2020
Lucas Henry Sater Individual Corporate OfficerVice President, Finance Mar 3, 2025
Corporate DirectorVice President, Finance Mar 3, 2025

Owners & managing parties with NPI records 5

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.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

Affiliated clinicians 268

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

View all 268

NPI Registry JSON

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1992701825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1070",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206461070",
            "telephone_number": "301-609-5163",
            "fax_number": "301-934-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 GARRETT AVENUE",
            "city": "LA PLATA",
            "state": "MD",
            "postal_code": "206461070",
            "telephone_number": "301-609-4474",
            "fax_number": "301-609-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVISTA MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "ZANGER",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-609-5163"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003355200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Plata, MD

Sources for this page

Verify at the official NPI Registry.