NPIMap

Organization Active NPI

Crittenden Community Hospital LLC

Doing business as Crittenden Community Hospital

  • Rural Acute Care Hospital
  • Marion, KY
National Provider Identifier
1053885392
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
Legal business name
CRITTENDEN COMMUNITY HOSPITAL LLC
Doing business as
Crittenden Community Hospital
Practice address
520 W Gum St
Marion, KY 42064-1516
Phone
(270) 965-1042
Fax
(270) 965-1061
NPI assigned
Jan 21, 2019
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Darrel Morris
Title
Coo
Phone
(918) 527-1234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X
Rural Acute Care Hospital 282NR1301X Primary

Addresses

Primary practice location

520 W Gum St
Marion, KY 42064-1516

Mailing address

520 W Gum St
Marion, KY 42064-1516
Phone (270) 965-1042

Other names 1

  • Crittenden Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240111001163 KY Part A Provider - Rural Emergency Hospital (Reh) 8426398793 Practice locations: Marion, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053885392. Details of each certification follow.

Hospital certification: CCN 180779

Legal name
CRITTENDEN COMMUNITY HOSPITAL LLC
Certification status
Active
Provider type (POS)
Hospital – Rural emergency hospital
Participating since
Mar 13, 2024
Last certification
Mar 13, 2024
Beds
1
Ownership / control type
Local
Organization structure
LLCProprietary
Incorporated
Oct 9, 2018 in KY
Enrollment address
520 W Gum St
Marion, KY 42064-1516
Other Hospital Practice Location

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Crittenden Community HospitalCCN 180779 · All quality measures
Type
Rural Emergency Hospital
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

417 N Main St
Sturgis, KY 42459
Phone (270) 374-6400

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Darrel W Morris Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.22%
Corporate OfficerCoo, Board Member Dec 28, 2018 16.22%
Corporate DirectorCoo Board Member Dec 28, 2018 16.22%
Operational/Managerial Control Dec 28, 2018 16.22%
RHG Consolidated LLC Organization, Kansas City, MO LLC 5% Or Greater Direct Ownership Interest Dec 28, 2018 100%
Operational/Managerial Control Dec 28, 2018 100%
Phyllis Shaffer Individual Corporate DirectorOwner Dec 5, 2024 6.08%
Lawrence J Arthur Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Trent M Skaggs Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Corporate OfficerCeo, Board Member Dec 28, 2018 16.67%
Corporate DirectorCeo Board Member Dec 28, 2018 16.67%
Operational/Managerial ControlCeo Board Member Dec 28, 2018 16.67%
LG Medical LLC Organization, Kansas City, MO LLC 5% Or Greater Indirect Ownership Interest Apr 13, 2020 12.97%
Brent Lagergren Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 6.09%
Corporate OfficerVP,Cco and Asst Sec Dec 28, 2018 6.09%
Billy W May Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 5.63%
Corporate DirectorVP Reg Oper Board Member Dec 28, 2018 5.63%
Operational/Managerial ControlVP Reg Oper Board Member Dec 28, 2018 5.63%
Dennis L Davis Individual 5% Or Greater Indirect Ownership Interest Dec 28, 2018 16.67%
Jami Homfeld Individual Corporate DirectorOwner Dec 5, 2024 3%

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

Affiliated clinicians 40

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

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1548028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1053885392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 W GUM ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516",
            "telephone_number": "270-965-1042",
            "fax_number": "270-965-1061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 W GUM ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641516",
            "telephone_number": "270-965-1042",
            "fax_number": "270-965-1061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRITTENDEN COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-21",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-527-1234"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crittenden Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crittenden Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KY

Sources for this page

Verify at the official NPI Registry.