NPIMap

Organization Active NPI

Freeman Neosho Hospital

  • Rural Health Clinic/Center
  • Neosho, MO
National Provider Identifier
1043631203
Registry record updated Dec 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FREEMAN NEOSHO HOSPITAL
Practice address
336 S Jefferson St
Neosho, MO 64850-1769
Phone
(417) 455-4200
NPI assigned
Dec 13, 2013
Last updated
Dec 13, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2013

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

Authorized official

Name
Steven W Graddy
Title
Cfo
Phone
(417) 347-6678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

336 S Jefferson St
Neosho, MO 64850-1769

Mailing address

1102 W 32ND St
Joplin, MO 64804-3503
Phone (417) 347-1111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140214000218 MO Part A Provider - Rural Health Clinic 4284624552 Practice locations: Neosho, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043631203. Details of each certification follow.

Rural health clinic certification: CCN 268722

Legal name
FREEMAN NEOSHO HOSPITAL
Doing business as
FREEMAN NEOSHO PHYSICIAN GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2014
Last certification
Apr 27, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
336 S Jefferson St
Neosho, MO 64850-1769
Related CCNs
261331

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Jeffery a Wool MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Networks

  • devoted network organization-4d06b5ed-aefa-4033-b81c-2adf126fd114

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Leesa Apfelbaum Individual W-2 Managing Employee Jun 17, 2009
Renee Denton Individual W-2 Managing EmployeeAdministrative Services Director Sep 24, 2012
Operational/Managerial ControlAdministrative Services Director Sep 24, 2012
Gary Wasson Individual Corporate Director Jan 1, 2009
Deeanne Evenson Individual Corporate Director Oct 5, 2005
Steven W Graddy Individual Corporate OfficerCfo Nov 1, 2007
W-2 Managing EmployeeCfo Nov 1, 2007
Rudy Farber Individual Corporate Director Oct 5, 2005
Freeman Neosho Hospital Organization, Neosho, MO Non-profit Operational/Managerial Control Feb 1, 2014 100%
Paula Baker Individual Corporate OfficerPresident & Ceo Jan 1, 2012
Corporate DirectorPresident & Ceo Jan 1, 2012
Operational/Managerial ControlPresident & Ceo Jan 1, 2012
Freeman-Oak Hill Health System Organization, Joplin, MO Non-profit Operational/Managerial Control Feb 1, 2014 100%
Mitch McCumber Individual Corporate Director Oct 5, 2005
Larry G Barnes Individual Corporate Director Oct 5, 2005

Owners & managing parties with NPI records 20

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

View all 20

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Freeman Clinic of AndersonAnderson, MO, CCN 268773 Rural health clinic Operational/Managerial Control (100%) Jul 1, 2018

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 8

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

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386892800000",
    "number": "1043631203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 W 32ND ST",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648043503",
            "telephone_number": "417-347-1111",
            "fax_number": "417-347-0702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "336 S JEFFERSON ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648501769",
            "telephone_number": "417-455-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEMAN NEOSHO HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-13",
        "last_updated": "2013-12-13",
        "status": "A",
        "authorized_official_last_name": "GRADDY",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-347-6678"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neosho, MO

Sources for this page

Verify at the official NPI Registry.