NPIMap

Organization Active NPI

State of Missouri

Doing business as Hawthorn Children's Psychiatric Hosptial

  • Psychiatric Hospital
  • Saint Louis, MO
National Provider Identifier
1033289897
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
EXEMPT Issued in MO
Legal business name
STATE OF MISSOURI
Doing business as
Hawthorn Children's Psychiatric Hosptial
Practice address
1901 Pennsylvania Ave
Saint Louis, MO 63133-1325
Phone
(314) 512-7800
Fax
(314) 512-7812
NPI assigned
Nov 9, 2006
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Molly Jane Boeckmann
Title
Director of Administrative Services
Phone
(573) 751-4055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X EXEMPT MO Primary

Addresses

Primary practice location

1901 Pennsylvania Ave
Saint Louis, MO 63133-1325

Mailing address

PO Box 687
Jefferson City, MO 65102-0687
Phone (573) 751-3398

Other identifiers 1

IdentifierTypeStateIssuer
021774005MedicaidMO

Other names 1

  • Hawthorn Children's Psychiatric Hosptial Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120103000181 MO Part A Provider - Hospital 1456254226 Practice locations: Saint Louis, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1033289897. Details of each certification follow.

Hospital certification: CCN 264028

Legal name
STATE OF MISSOURI
Doing business as
HAWTHORN CHILDREN'S PSYCHIATRIC HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Feb 9, 2012
Last certification
Feb 11, 2015
Beds
44
Ownership / control type
State
Organization structure
GovernmentNon-profit
Incorporated
in MO
Enrollment address
1901 Pennsylvania Ave
Saint Louis, MO 63133-1325
Hospital Psychiatric Unit
Hospital subgroups
Children’s, Psychiatric

Psychiatric residential treatment facility certification: CCN 26L001

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HAWTHORN CHILDREN'S PSYCHIATRIC HOSPITAL
Certification status
Active
Provider type (POS)
Psychiatric residential treatment facility
Participating since
Aug 1, 2004
Last certification
Aug 28, 2024
Beds
24
Ownership / control type
Non-profit – other
Facility address
1901 Pennsylvania Avenue
Saint Louis, MO 63133

Other NPIs with the same Medicare PAC ID 11

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0926457Hawthorn Children's Psychiatric Hospital1901 Pennsylvania, Saint Louis, MO 63133Certificate of waiverMar 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Western Missouri Mental Health Center104 organizations share this tax ID, including this one
Part of
Western Missouri Mental Health Center

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

1901 Pennsylvania Ave
Saint Louis, MO 63133
Phone (314) 512-7800

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Molly Boeckmann Individual Corporate Director Jul 1, 2020
W-2 Managing Employee Jul 1, 2020
State of Missouri Organization, Jefferson City, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1981 100%
Gloria Gehlert Individual W-2 Managing EmployeeReimbursement Administrator Apr 16, 2016
Holly Coil Individual W-2 Managing Employee Oct 1, 2019
Kimberly Feaman Individual W-2 Managing Employee Jun 1, 2019
Jennifer Bax Individual W-2 Managing Employee Jul 1, 2023

Owners & managing parties with NPI records 11

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

  • State of Missouri

    dba Fulton State Hospital

    • Psychiatric Hospital
    • Fulton, MO
    • NPI 1104878792

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Northwest MO Psychiatric Rehabilitation Center

    • Psychiatric Hospital
    • Saint Joseph, MO
    • NPI 1104879444

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Fulton State Hospital

    • Psychiatry Physician
    • Fulton, MO
    • NPI 1164477873

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St. Louis Developmental Disabilities Treatment Center

    • General Practice Physician
    • Saint Charles, MO
    • NPI 1316991896

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatry Physician
    • Saint Louis, MO
    • NPI 1427002013

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Southeast MO Mental Health Center

    • Psychiatry Physician
    • Farmington, MO
    • NPI 1437106705

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Center for Behavioral Health

    • Psychiatry Physician
    • Kansas City, MO
    • NPI 1497709083

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1578518239

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Bellefontaine Habilitation Center

    • Physical Medicine & Rehabilitation Physician
    • Saint Louis, MO
    • NPI 1710931167

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Center for Behavioral Medicine

    • Psychiatric Hospital
    • Kansas City, MO
    • NPI 1730134495

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Southeast MO Mental Health Center

    • Psychiatric Hospital
    • Farmington, MO
    • NPI 1861447526

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Center for Behavioral MedicineKansas City, MO, CCN 264008 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
St Louis Forensic Treatment CenterSaint Louis, MO, CCN 264010 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Southeast Missouri Mental Health CenterFarmington, MO, CCN 264005 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Fulton State HospitalFulton, MO, CCN 264004 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Northwest Missouri Psychiatric Rehabilitation CenterSaint Joseph, MO, CCN 264007 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • State of Missouri

    dba Fulton State Hospital

    • Psychiatric Hospital
    • Fulton, MO
    • NPI 1104878792

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Northwest MO Psychiatric Rehabilitation Center

    • Psychiatric Hospital
    • Saint Joseph, MO
    • NPI 1104879444

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1578518239

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Center for Behavioral Medicine

    • Psychiatric Hospital
    • Kansas City, MO
    • NPI 1730134495

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Southeast MO Mental Health Center

    • Psychiatric Hospital
    • Farmington, MO
    • NPI 1861447526

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1033289897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651020687",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 PENNSYLVANIA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631331325",
            "telephone_number": "314-512-7800",
            "fax_number": "314-512-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "MO",
            "license": "EXEMPT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021774005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawthorn Children's Psychiatric Hosptial",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hawthorn Children's Psychiatric Hosptial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.