No
Cameron ENT
306 East Maumee Street
Suite 301
Angola, IN 46703
| CAH151315-01 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | Rural Health Clinic II (Urgent Care) | 1381 NORTH WAYNE STREET | ANGOLA | IN | Active |
| CAH151315-02 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | Clinic - Ortho (Cameron Orthopedics) | 306 E MAUMEE ST STE 304 | ANGOLA | IN | Active |
| CAH151315-03 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | Rural Health Clinic (Cameron Family Medicine W Maumee) | 1500 W MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-04 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | THE REGIONAL CANCER CARE CENTER OF - Oncology | 516 E MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-05 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON MEMORIAL COMM HOSPITAL INC - Cameron Family Practice | 401 S BROAD ST STE D | FREMONT | IN | Active |
| CAH151315-06 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON MEMORIAL COMMUNITY HOSPITAL - Psychiatry | 301 E MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-07 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | Clinic (ATU Clinic) | 416 E Maumee St | ANGOLA | IN | Active |
| CAH151315-08 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | THE CAMERON SLEEP DISORDER FACILITY - Cameron Sleep Disorder Facility | 306 E MAUMEE ST Suite 006 | ANGOLA | IN | Active |
| CAH151315-09 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON MEMORIAL COMM HOSPITAL INC - Cameron ENT | 306 E MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-10 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON MEMORIAL COMM HOSPITAL INC - Pediatrics | 306 E MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-11 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON MEMORIAL COMM HOSPITAL INC - Cameron Family Practice | 306 E MAUMEE ST | ANGOLA | IN | Terminated |
| CAH151315-12 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | Rural Health Clinic III (Cameron OB/GYN) | 306 E Maumee St Suite 101 | Angola | IN | Active |
| CAH151315-13 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | CAMERON CARDIOLOGY - Cardiology | 306 E MAUMEE ST | ANGOLA | IN | Active |
| CAH151315-14 | Child | CAH | CAMERON MEMORIAL COMMUNITY HOSPITAL | RHC IV CFM North - Cameron Family Medicine North | 3250 Intertech Dr Ste A | Angola | IN | Active |
| Details | Last Recertification Date | Update | Recertification | 8/21/2023 10:56:28 AM | 8/14/2024 8:40:17 AM | 8/14/2024 8:40 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 11:19:35 PM | 8/21/2023 10:56:28 AM | 8/21/2023 10:56 AM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 20140649B (IN) | | 10/11/2022 3:34 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1396895710 (IN) | | 10/11/2022 3:34 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1770521478 (IN) | | 10/11/2022 3:34 PM |
| Details | Last Recertification Date | Update | Recertification | 8/18/2021 8:55:29 AM | 8/29/2022 11:19:35 PM | 8/29/2022 11:19 PM |
| Contacts | Primary Contact | Update | Group Change Request | ALDRED, ANDREW
DIRECTOR OF PHARMACY
Cameron Memorial Community Hospital
2606675330 | Crabill, Jonathan
Pharmacy Director
Cameron Memorial Community Hospital, Inc.
2606675427 | 9/22/2021 6:30 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2020 8:39:42 AM | 8/18/2021 8:55:29 AM | 8/18/2021 8:55 AM |
| Contacts | Authorizing Official | Update | Change Request | McCahill, Connie
CEO
Cameron Memorial Community Hospital
2606675130 | Logan, Angela
CEO
Cameron Memorial Community Hospital, Inc.
2606675735 | 5/10/2021 10:27 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/24/2020 8:39 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 20140649B | 8/24/2020 8:39 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | IN | 8/24/2020 8:39 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | IN | 8/24/2020 8:39 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1770521478 | 8/24/2020 8:39 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IN | 8/24/2020 8:39 AM |
| Details | Last Recertification Date | Update | Recertification | | 8/24/2020 8:39:42 AM | 8/24/2020 8:39 AM |
| Details | State | Update | OPA Edit | Approved | Active | 8/5/2020 8:14 AM |
| Dates | Start Date | Update | OPA Edit | 10/1/2020 12:00:00 AM | 8/5/2020 12:00:00 AM | 8/5/2020 8:14 AM |
| Contacts | Signed By | Insert | New Registration | | McCahill, Connie
CEO
Cameron Memorial Community Hospital
2606675130 | 7/30/2020 1:01 PM |
| Details | 340B ID | Update | New Registration | | CAH151315-09 | 7/30/2020 1:01 PM |
| Details | Entity Subname | Update | New Registration | CAMERON MEMORIAL COMM HOSPITAL INC | CAMERON MEMORIAL COMM HOSPITAL INC - Cameron ENT | 7/30/2020 1:01 PM |
| Dates | Participating Approval Date | Update | New Registration | | 7/30/2020 1:01:29 PM | 7/30/2020 1:01 PM |
| Details | State | Update | New Registration | Pending | Approved | 7/30/2020 1:01 PM |
| Dates | Signed By Date | Update | New Registration | | 7/15/2020 8:12:49 AM | 7/30/2020 1:01 PM |
| Dates | Start Date | Update | New Registration | | 10/1/2020 12:00:00 AM | 7/30/2020 1:01 PM |
| Addresses | Main Address | Insert | New Registration | |
306 E MAUMEE ST
CAMERON MEDICAL OFFICE BUILDING
ANGOLA, IN 46703-2038 | 7/7/2020 3:46 PM |
| Addresses | Billing Address | Insert | New Registration | | Cameron ENT
306 East Maumee Street
Suite 301
Angola, IN 46703 | 7/7/2020 3:46 PM |
| Addresses | Shipping Address | Insert | New Registration | | Cameron ENT
306 East Maumee Street
Suite 301
Angola, IN 46703 | 7/7/2020 3:46 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1396895710 | 7/7/2020 3:46 PM |
| Contacts | Primary Contact | Insert | New Registration | | ALDRED, ANDREW
DIRECTOR OF PHARMACY
Cameron Memorial Community Hospital
2606675330 | 7/7/2020 3:46 PM |
| Contacts | Authorizing Official | Insert | New Registration | | McCahill, Connie
CEO
Cameron Memorial Community Hospital
2606675130 | 7/7/2020 3:46 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Details | Grant Number | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Details | 340B ID | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 151315 | 7/7/2020 3:46 PM |
| Details | Entity Name | Insert | New Registration | | CAMERON MEMORIAL COMMUNITY HOSPITAL | 7/7/2020 3:46 PM |
| Details | Program Code | Insert | New Registration | | CAH | 7/7/2020 3:46 PM |
| Details | Entity Subname | Insert | New Registration | | CAMERON MEMORIAL COMM HOSPITAL INC | 7/7/2020 3:46 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Details | State | Insert | New Registration | | Pending | 7/7/2020 3:46 PM |
| Dates | Registration Date | Insert | New Registration | | 7/7/2020 3:46:27 PM | 7/7/2020 3:46 PM |
| Dates | Signed By Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Dates | Start Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Terminations | Termination Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 7/7/2020 3:46 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 7/7/2020 3:46 PM |