Potosi Manor, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031634 Issued in MO

Legal business name

POTOSI MANOR, INC.

Doing business as

Potosi Manor

Practice address

307 South Highway 21
Potosi, MO 63664-9317

Phone

(573) 438-3225

Fax

(573) 438-1230

NPI assigned

Sep 22, 2005

Organization subpart

No

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

Authorized official

Name

Carla Hedrick, CFO

Title

Cfo

Phone

(573) 481-9625

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Potosi Manor Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Skilled nursing facility certification: CCN 265681

Legal name

POTOSI MANOR, INC.

Doing business as

POTOSI MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Aug 11, 1997

Last certification

Oct 11, 2024

Beds

90

Ownership / control type

Corporation

Multi-facility organization

Health Systems, Inc.

Organization structure

CorporationProprietary

Incorporated

Apr 1, 2002 in MO

Enrollment address

307 S State Highway 21
Potosi, MO 63664-9317

Nursing home name

POTOSI MANOR

Affiliated entity

JAMES & JUDY LINCOLN

Listed as

Potosi ManorCCN 265681 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

2 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Aug 11, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9052.1 residents per day on average

Chain

James & Judy Lincoln56 facilities in the chain

Penalties (3 years)

1Fines totaling $13,627

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 7

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Burke, M.D.

  • Internal Medicine Physician
  • Fredericktown, MO
  • NPI 1306885157
  NPD (past)
• Don Manarang, DO

  • Family Medicine Physician
  • Quincy, IL
  • NPI 1205833860
  NPD (past)

Affiliated clinicians 1

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

• Edward Burke, M.D.

  • Internal Medicine Physician
  • Fredericktown, MO
  • NPI 1306885157

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759363200000",
    "number": "1053307322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 SOUTH HIGHWAY 21",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636649317",
            "telephone_number": "573-438-3225",
            "fax_number": "573-438-1230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 SOUTH HIGHWAY 21",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636649317",
            "telephone_number": "573-438-3225",
            "fax_number": "573-438-1230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOSI MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A",
        "authorized_official_last_name": "HEDRICK",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-481-9625",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ID",
            "identifier": "16667131",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108841503",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "199.119.81.30:8291",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 w 108th ter",
            "city": "overland park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Potosi Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• PHGG, LLC
• Izet Porobic
• Marty J Portell
• Potosi Chiropractic Life Center
• Potosi Emergency Group, LLC
• Potosi Optometric Center
• Potosi R3 School District
• Potosi School District
• Potosi SNF Operations, LLC
• Pyatt Eye Care LLC

• Skilled Nursing Facility in Potosi, MO
• Providers in Potosi, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.