Russell County Community Hospital LLC
Organization Active NPI General Acute Care Hospital · Phenix City, AL
NPI 1023050101 · NPPES record last updated Apr 4, 2012
Key facts
- NPI
- 1023050101
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- H5703 (AL)
- Legal business name
- RUSSELL COUNTY COMMUNITY HOSPITAL LLC
- Practice address
- 4401 River Chase Dr
Phenix City, AL 36867-7483 - Phone
- (334) 732-3000
- Fax
- (334) 732-3020
- NPI assigned
- Jun 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Rachael H. Crenshaw
- Title
- Chief Operating Officer
- Phone
- (334) 732-3010
Owners & managing parties with NPI records 20
-
Champ L. Baker, MD
-
Thomas N. Bernard Jr., M.D.
-
John Kenneth Burkus, M.D.
-
John D. Dorchak, M.D.
-
Patrick J. Fernicola, M.D.
-
Frederick C. Flandry, M.D.
-
Ryan M Geringer, DO
-
David Michael Gloystein, M.D.
-
Garland Keith Gudger Jr., M.D.
-
Kurt E. Jacobson, M.D.
-
David Hamilton Macdonald, D.O.
-
James E. McGrory, M.D.
-
Douglas Wesley Pahl, M.D.
-
David C. Rehak, M.D.
-
Randall Joseph Ruark, M.D.
-
Carlton G. Savory, M.D.
-
Matthew Garrett Stewart, M.D.
-
Michael Matthews Tucker, M.D.
-
Benjamin Collier Watson, D.O.
-
Lance Erik Westerlund, M.D.
Practitioners 21
-
Ritu Chandra, MD
-
James Christian Coleman, M.D., MPA
-
Joseph Earl Conklin Jr., M.D.
-
Daryl Ellis, MD
-
Riliwanu Aliu, MD
-
Rajesh Arora, MD
-
Juan Ayerdi, MD
-
Jared A Brummel, D.O.
-
Greyson Scott Chappelle, M.D.
-
Vikramjit S Chhokar, M.D.
-
Timothy Alan Coakley, M.D.
-
Garland Keith Gudger Jr., M.D.
-
Lance Erik Westerlund, M.D.
Affiliated clinicians 100
-
Mohannad Fadl Azzam, M.D.
-
Jakira Z Banks, CRNA
-
Tanner Coggin Clay, DNP
-
Joseph Earl Conklin Jr., M.D.
-
Jeffrey Scott Davidson, D.O.
-
Daryl Ellis, MD
-
Keith Lyle Fuller, D.O.
-
Qamar Gulzar, MD
-
Aryn Hueston, FNP
-
Alto Lee Johnson III, CRNA
-
Michael W Johnston, M.D.
-
Rekha Lall, MD
-
Donald O Okeakpu, MD
-
Milton Earl Pointer Jr., CRNA
-
Javaris Polk, CRNA
-
Elizabeth Buss Robinson, M.D.
-
Rodney D Soto, MD
Medicare Care Compare: Hospital
- Listed as
- Jack Hughston Memorial Hospital
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - State
- Medicare certification status
- Active
- Emergency services
- Yes
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D1054322 | Jack Hughston Memorial Hospital Lab | Accreditation | Nov 5, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Hospital certification: CCN 010168
- Legal name
- RUSSELL COUNTY COMMUNITY HOSPITAL, LLC
- Doing business as
- JACK HUGHSTON MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Sep 1, 2006
- Last certification
- Sep 2, 2006
- Beds
- 70
- Ownership / control type
- State
- Organization structure
- LLC · Proprietary
- Incorporated
- Apr 8, 2003 in AL
- Enrollment address
- 4401 River Chase Dr
Phenix City, AL 36867-7483 - Hospital subgroups
- General
All disclosed owners & managing parties 26
| Name | Role | Since | Share |
|---|---|---|---|
| Champ L Baker |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| L Erik Westerlund |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| James McGrory |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Lyle a Norwood |
Other |
Jan 1, 2025 | 2% |
| Garland Kieth Gudger |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Benjamin Watson |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Carlton G Savory |
Other |
Jan 1, 2025 | 2% |
| David C Rehak |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Ryan M Geringer |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Patrick J Fernicola |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| David H Macdonald |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| John K Burkus |
Other |
Jan 1, 2025 | 2% |
| Mark Baker |
Corporate Officer |
Feb 5, 2009 | |
| Corporate Director | Feb 5, 2009 | ||
| Randall Joseph Ruark |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Curtis Keith Harnage |
W-2 Managing Employee |
Dec 31, 2022 | |
| Douglas W Pahl |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| David Michael Gloystein |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Kurt E Jacobson |
Other |
Jan 1, 2025 | 4% |
| Thomas N Bernard |
Other |
Jan 1, 2025 | 2% |
| Matthew Garrett Stewart |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Rachael Crenshaw |
Corporate Officer |
Dec 31, 2022 | |
| Operational/Managerial Control |
Dec 31, 2022 | ||
| Norman L Donati |
Other |
Jan 1, 2025 | 2% |
| John D Dorchak |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Michael M Tucker |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
| Garland K Gudger |
Other |
Jan 1, 2025 | 2% |
| Frederick C. Flandry |
5% Or Greater Direct Ownership Interest |
Jan 1, 2025 | 5.25% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060714000105 | AL | Part a Provider - Hospital | 6305859372 | Practice locations: Phenix City, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | H5703 | AL | Yes |
| General Acute Care Hospital | 282N00000X |
Addresses
Primary practice location
4401 River Chase Dr
Phenix City, AL 36867-7483
Mailing address
4401 River Chase Drive
Phenix City, AL 36867-7483
Phone (334) 732-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| H050168H | Medicaid | AL |
Other names
- Jack Hughston Memorial Hospital
Other providers in Phenix City, AL
- Elizabeth Buss Robinson
- Elizabeth A. Romey
- Jessica Ross
- Russell County
- Russell County Child Advocacy Center
- Russell County Community Hospital, LLC
- Russell County Health Dept Adult Immun
- Russell County Health Dept AIDS
- Russell County Health Dept Child
- Russell County Health Dept Epsdt
All providers in Phenix City, AL · General Acute Care Hospital in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2012. 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.