NPIMap

Organization Active NPI

Russellville Holdings LLC

Doing business as St . Mary's Regional Medical Center

  • General Acute Care Hospital
  • Russellville, AR
National Provider Identifier
1033160049
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4192 Issued in AR
Legal business name
RUSSELLVILLE HOLDINGS LLC
Doing business as
St . Mary's Regional Medical Center
Practice address
1808 W Main St
Russellville, AR 72801-2724
Phone
(479) 968-2841
Fax
(479) 968-8189
NPI assigned
May 14, 2006
Last updated
Jul 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 4192 AR
General Acute Care Hospital 282N00000X 4192 AR Primary
Social Worker 104100000X
Physical Therapist 225100000X
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

1808 W Main St
Russellville, AR 72801-2724

Mailing address

103 Continental PL
Suite 200
Brentwood, TN 37027-1041
Phone (615) 844-9800

Other identifiers 1

IdentifierTypeStateIssuer
152329105MedicaidAR

Other names 1

  • St . Mary's Regional Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address saintmarysregmedcen@smrmc.medalliesdirect.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031208000790 AR Part A Provider - Hospital 1052217452 Practice locations: Russellville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033160049. Details of each certification follow.

Hospital certification: CCN 040041

Legal name
RUSSELLVILLE HOLDINGS LLC
Doing business as
ST MARY'S REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 24, 2021
Beds
170
Ownership / control type
Private (for profit)
Most recent change of ownership
Dec 1, 2003 (1 total)
Organization structure
LLCProprietary
Incorporated
Feb 3, 1999 in DE
Enrollment address
1808 W Main St
Russellville, AR 72801-2724
Other Hospital Practice Location
Hospital subgroups
Acute care, Rehabilitation

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Marys Regional Medical CenterCCN 040041 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Networks

  • devoted network organization-5b6e8479-727f-40cf-ba4e-9b59e43aa45e

Interoperability endpoints

  • Direct secure messaging: saintmarysregmedcen@smrmc.medalliesdirect.net

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
DSB Acquisition LLC Organization, New York, NY For-profit 5% Or Greater Indirect Ownership Interest May 2, 2016 100%
Casey Willis Individual Contracted Managing EmployeeFacility Ceo Apr 15, 2024
St Marys Holding LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 30, 2008 100%
Lifepoint Health Inc Organization, Brentwood, TN Corporation, For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Marcus B Poppell Individual Corporate OfficerSenior Vice President Nov 16, 2018
William Ziesmer Individual Corporate OfficerCfo Feb 12, 2024
Charlotte E Lawrence Individual Corporate OfficerSecretary Jan 21, 2022
Capella Holdings LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2016 100%
Capella Healthcare LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2016 100%
John Michael Grooms Individual Corporate OfficerSenior Vice President and Treasurer Nov 16, 2018
Christopher J Monte Individual Corporate OfficerVice President Nov 16, 2018
Jennifer Alderfer Individual Corporate OfficerPresident Oct 30, 2023
Lima Holdco LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Capella Health Holdings LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Aug 31, 2015 100%

Facilities with the same owner 34

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

View all 34

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 217

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

View all 217

NPI Registry JSON

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

{
    "created_epoch": "1147564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1033160049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CONTINENTAL PL",
            "address_2": "SUITE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370271041",
            "telephone_number": "615-844-9800",
            "fax_number": "615-844-9883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012724",
            "telephone_number": "479-968-2841",
            "fax_number": "479-968-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-14",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AR",
            "license": "4192",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "AR",
            "license": "4192",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152329105",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "saintmarysregmedcen@smrmc.medalliesdirect.net",
            "affiliation": "N",
            "address_1": "1808 W Main St",
            "city": "Russellville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "728012724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St . Mary's Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St . Mary's Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.