NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc

Doing business as Pilot Grove Medical Clinic at Fitzgibbon

  • Rural Health Clinic/Center
  • Pilot Grove, MO
National Provider Identifier
1073279873
Registry record updated Jun 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
Pilot Grove Medical Clinic at Fitzgibbon
Practice address
212 College St
Pilot Grove, MO 65276-1005
Phone
(660) 831-3728
NPI assigned
Nov 16, 2021
Last updated
Jun 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 19, 2024

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

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7431

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

212 College St
Pilot Grove, MO 65276-1005

Mailing address

PO Box 801303
Kansas City, MO 64180-1303
Phone (660) 831-3728

Other identifiers 1

IdentifierTypeStateIssuer
268790MedicaidMO

Other names 1

  • Pilot Grove Medical Clinic at Fitzgibbon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040315000980 MO Part B Supplier - Clinic/Group Practice 2567351570 Receives reassigned benefits from 68 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, MO; Pilot Grove, MO
O20080104000462 MO Part A Provider - Hospital 2567351570 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brunswick, MO; Fayette, MO; Marshall, MO; Pilot Grove, MO; Slater, MO
O20220621001658 MO Part A Provider - Rural Health Clinic 2567351570 Practice locations: Pilot Grove, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1073279873. Details of each certification follow.

Hospital certification: CCN 260142

Legal name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
FITZGIBBON HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 13, 2023
Beds
60
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
2305 S Highway 65
Marshall, MO 65340-3702
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved, Psychiatric unit

Rural health clinic certification: CCN 268790

Legal name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
PILOT GROVE MEDICAL CLINIC AT FITZGIBBON
Organization structure
CorporationNon-profit
Incorporated
Apr 12, 1961 in MO
Enrollment address
212 College St
Pilot Grove, MO 65276-1005

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

Care Compare: Hospital

Medicare Care Compare
Listed as
Fitzgibbon HospitalCCN 260142 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
26D1039724Pilot Grove Medical Clinic at Fitzgibbon212 College Street, Pilot Grove, MO 65276Certificate of waiverApr 19, 2027

National Provider Directory

National Provider Directory
Part of
Eastwood Family Clinic

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
John Fitzgibbon Memorial Hospital Inc Organization, Marshall, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Operational/Managerial Control Jul 1, 1966
Operational/Managerial Control Jan 1, 2022
Jan Stapleton Individual Other Sep 22, 2015
Corporate DirectorBoard Member Sep 22, 2015
Scott Hartwig Individual OtherSecretary Sep 22, 2015
Corporate DirectorBoard Member Sep 22, 2015
Darin L Haug Individual W-2 Managing EmployeeCmo Sep 1, 2012
William L Summers Individual OtherPresident Jan 1, 1999
Corporate DirectorBoard Member Jan 1, 1999
Mary Lou Porter Individual Other Oct 25, 2016
Corporate DirectorBoard Member Oct 25, 2018
Nancy K Harris Individual Corporate OfficerCfo Feb 14, 2020
W-2 Managing Employee Feb 14, 2020
Angela P Littrell Individual Corporate OfficerPresident & Ceo Feb 14, 2020
W-2 Managing Employee Jun 2, 2014
Corporate OfficerPresident and Ceo Mar 14, 2020
Operational/Managerial ControlPresident/Ceo Jan 1, 2022
Jared K Romney Individual OtherPresident of Medical Staff May 1, 2023
Angela Igo Individual W-2 Managing EmployeeCno Jan 1, 2016
Thomas Jones Individual W-2 Managing EmployeeCio Feb 1, 2011
Jason Gault Individual Corporate DirectorBoard Member May 1, 2021
Andrew J Snyder Individual Corporate OfficerDirector of Physician Services Mar 14, 2020
Jill Lilleman Individual Corporate DirectorBoard Member Oct 25, 2016

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
Fitzgibbon HospitalMarshall, MO, CCN 260142 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 1966
Jul 1, 1966
Fitzgibbon HospitalMarshall, MO, CCN 26S142 Hospital Operational/Managerial Control (100%) Jul 1, 1966
The Living CenterMarshall, MO, CCN 265688 Skilled nursing facility Operational/Managerial Control (10%) Jul 5, 1995
Fitzgibbon Professional BuildingMarshall, MO, CCN 268577 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 1996
Jun 1, 1996
Akeman McBurney Health ClinicSlater, MO, CCN 268671 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 16, 2012
Nov 1, 2010
Fitzgibbon Family HealthFayette, MO, CCN 268731 Rural health clinic Operational/Managerial Control Aug 1, 2014
Mid-Missouri Family Health at FitzgibbonMarshall, MO, CCN 268789 Rural health clinic Operational/Managerial Control Apr 1, 2020

Owned or controlled facilities with NPI records 14

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

View all 14

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 130

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

View all 130

NPI Registry JSON

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

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1073279873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801303",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801303",
            "telephone_number": "660-831-3728",
            "fax_number": "660-831-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 COLLEGE ST",
            "city": "PILOT GROVE",
            "state": "MO",
            "postal_code": "652761005",
            "telephone_number": "660-831-3728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2021-11-16",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7431"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268790",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pilot Grove Medical Clinic at Fitzgibbon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pilot Grove Medical Clinic at Fitzgibbon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pilot Grove, MO

Sources for this page

Verify at the official NPI Registry.