NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc

Doing business as Marshall Family Practice

  • Clinic/Center
  • Marshall, MO
National Provider Identifier
1093731986
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
Marshall Family Practice
Practice address
2305 South 65 Highway, Building a
Marshall, MO 65340-3702
Phone
(660) 886-7800
Fax
(660) 831-3328
NPI assigned
Jul 14, 2006
Last updated
Mar 5, 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 Mar 5, 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) 886-7231

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

2305 South 65 Highway, Building a
Marshall, MO 65340-3702

Mailing address

2305 South 65 Highway, Building a
Marshall, MO 65340-3702
Phone (660) 886-7800

Other names 1

  • Marshall Family Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

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
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093731986. 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

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

National Provider Directory

National Provider Directory
Part of
Grandriver Medical Clin

Locations

2305 S Highway 65
Marshall, MO 65340
Phone (660) 831-3730

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
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
Jan Stapleton Individual Other Sep 22, 2015
Scott Hartwig Individual OtherSecretary Sep 22, 2015
Darin L Haug Individual W-2 Managing EmployeeCmo Sep 1, 2012
William L Summers Individual OtherPresident Jan 1, 1999
Mary Lou Porter Individual Other Oct 25, 2016
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
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

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 8

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
Pilot Grove Medical Clinic at FitzgibbonPilot Grove, MO, CCN 268790 Rural health clinic Operational/Managerial Control Jan 1, 2022

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

Practitioners & affiliated clinicians

Practitioners 72

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 72

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": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1093731986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY, BUILDING A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800",
            "fax_number": "660-831-3328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY, BUILDING A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800",
            "fax_number": "660-831-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7231"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marshall Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marshall Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.