NPIMap

Organization Active NPI

Hannibal Regional Healthcare System,Inc

Doing business as Express Care at Walmart

  • Rural Health Clinic/Center
  • Hannibal, MO
National Provider Identifier
1083154991
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HANNIBAL REGIONAL HEALTHCARE SYSTEM,INC
Doing business as
Express Care at Walmart
Practice address
3650 Stardust Dr
Hannibal, MO 63401-2480
Phone
(573) 231-0660
Fax
(573) 231-0687
NPI assigned
Feb 27, 2017
Last updated
Feb 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Authorized official

Name
Robert Gasaway
Title
Cfo
Phone
(573) 406-1609

Specialties & licenses 1

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

Addresses

Primary practice location

3650 Stardust Dr
Hannibal, MO 63401-2480

Mailing address

PO Box 801222
Kansas City, MO 64180-1222
Phone (573) 248-5672

Other names 1

  • Express Care at Walmart Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170711002093 MO Part A Provider - Rural Health Clinic 1254236300 Practice locations: Hannibal, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083154991. Details of each certification follow.

Rural health clinic certification: CCN 268759

Legal name
HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Doing business as
EXPRESS CARE AT WALMART
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 7, 2017
Last certification
Nov 7, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 6, 1965 in MO
Enrollment address
3650 Stardust Dr
Hannibal, MO 63401-2480
Related CCNs
260025

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

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
26D2029622Express Care at Walmart3650 Stardust Drive, Hannibal, MO 63401Certificate of waiverSep 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hannibal Regional Hosp33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

3650 Stardust Dr
Hannibal, MO 63401
Phone (573) 231-0660

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Hannibal Regional Healthcare System Inc Organization, Hannibal, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2016 100%
Operational/Managerial Control Oct 1, 2012
Robert N Gasaway Individual Corporate OfficerCfo Feb 6, 2017 100%
W-2 Managing EmployeeCfo Feb 6, 2017 100%
Operational/Managerial ControlCfo Feb 6, 2017
Christopher T Ahrens Individual Corporate OfficerCeo Oct 1, 2012 100%
W-2 Managing EmployeeCeo Oct 1, 2012 100%
Operational/Managerial ControlCeo Oct 1, 2012

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Hannibal Regional HospitalHannibal, MO, CCN 260025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Inpatient RehabilitationHannibal, MO, CCN 26T025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Hospital Home Health AgencyHannibal, MO, CCN 267282 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 22, 2012
Feb 6, 2017
Monroe City Family PracticeMonroe City, MO, CCN 268513 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Shelbina Family PracticeShelbina, MO, CCN 268512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Canton-Lagrange Family PracticeCanton, MO, CCN 263984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 3, 1992
Apr 30, 1992
Pike Medical ClinicLouisiana, MO, CCN 268723 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical Group-Bowling GreenBowling Green, MO, CCN 268724 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical GroupHannibal, MO, CCN 268754 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016
Complete Family Medicine Lancaster RHCLancaster, MO, CCN 268757 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine la Plata RHCLa Plata, MO, CCN 268756 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine Kirksville RHCKirksville, MO, CCN 268758 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017

Owned or controlled facilities with NPI records 12

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

Facilities with the same owner 12

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": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488153600000",
    "number": "1083154991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801222",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801222",
            "telephone_number": "573-248-5672",
            "fax_number": "573-248-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 STARDUST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012480",
            "telephone_number": "573-231-0660",
            "fax_number": "573-231-0687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL REGIONAL HEALTHCARE SYSTEM,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A",
        "authorized_official_last_name": "GASAWAY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-406-1609"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Express Care at Walmart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.