Kirksville Missouri Hospital Company, LLC
Organization Active NPI General Acute Care Hospital · Kirksville, MO
NPI 1104899442 · NPPES record last updated Apr 8, 2021
Key facts
- NPI
- 1104899442
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 462-4 (MO)
- Legal business name
- KIRKSVILLE MISSOURI HOSPITAL COMPANY, LLC
- Practice address
- 315 S Osteopathy
Kirksville, MO 63501-6401 - Phone
- (660) 785-1000
- NPI assigned
- Feb 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Paula M Lalor
- Title
- Director/Delegated Official
- Phone
- (629) 215-3953
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Related certifications (CCN) 2
Facilities with the same owner 120
Practitioners 66
-
Kade Earl Kinney, DO
-
Jacqueline Elise Kirkpatrick, FNP-BC
-
Nancy Lynn Rourke, CNP
-
Valena Fiscus, D.O.
-
Tysen J Petre, D.O.
-
John Dee Bailey, D.O.
-
Samantha Jane Bishop, M.A., CCC-SLP
-
Jennifer L Blanke, DPT
-
Melissa A Brown, OTR/L, PTA
-
Penny L. Brummer, PTA
-
Nancy A Bucher, MA, CCC-SLP
-
Terri Lynn Clay, MA, CCC-SLP
-
Krista R. Cooper, PTA
-
Mallory A Curtis, DPT
-
Ronald L Danielson Jr., MPT, MS
-
Brittany Eagen, DPT
-
Kinsley Fitzpatrick, DPT
-
Ashley Gaines, DPT
-
Shelly L. Gray, PTA
-
Betsey D Gundy, COTA
-
Larry R Handlin, DO
-
Roxana Ionas, MD
Affiliated clinicians 212
-
James Hughes Adams, D.O.
-
Humera Ahsan, M.D.
-
Ameena Anees, MD
-
Azhar Assadi, DO
-
John Dee Bailey, D.O.
-
Eric A. Barnes, D.O.
-
Jonathan Daniel Barnes, AGPCNP-BC
-
Aurora C. Bell, DO
-
Ann Marie Bibbs, MSN, RN, NP-C
-
Lillian Jean Bruner, NP-C
-
Julie L Burdin, MD
-
Lisa Butler, CRNA
-
Steven Shing Yan Cheung, M.D.
-
Lloyd J Cleaver, DO
-
John C Collins, DO
Medicare Care Compare: Hospital
- Listed as
- Northeast Regional Medical Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Hospital certification: CCN 260022
- Legal name
- KIRKSVILLE MISSOURI HOSPITAL COMPANY LLC
- Doing business as
- NORTHEAST REGIONAL MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- May 22, 2019
- Beds
- 194
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Enrollment address
- 315 S Osteopathy Ave
Kirksville, MO 63501-6401 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin J Hammons |
Corporate Officer |
Feb 27, 2012 | |
| Corporate Director |
Jan 1, 2020 | ||
| Nathaniel K Summar |
Corporate Director |
Jul 15, 2017 | |
| Justin D Pitt |
Corporate Officer |
Mar 1, 2022 | |
| Corporate Director |
Mar 1, 2022 | ||
| CHS Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Mar 2, 2012 | 100% |
| William Bradley Cash |
Corporate Officer |
Jun 1, 2018 | |
| Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Feb 1, 2011 | 100% |
| Jason Kevin Johnson |
Corporate Officer |
Jan 6, 2020 | |
| Roman Gabriel Ottinger |
Corporate Officer |
Jan 6, 2020 | |
| Kirksville Hospital Company, LLC |
5% Or Greater Direct Ownership Interest | Dec 31, 2007 | 98.7% |
| Paula M Lalor |
Corporate Director |
Apr 1, 2017 | |
| Patrick Avila |
W-2 Managing Employee |
Sep 11, 2022 | |
| Edna S Buffington-Price |
Corporate Director |
Mar 1, 2022 | |
| Community Health Investment Company LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2007 | 100% |
| Christopher G Cobb |
Corporate Officer |
Apr 1, 2017 | |
| CHS Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Mar 2, 2012 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050713000947 | MO | Part a Provider - Hospital | 3274517347 | Practice locations: Kirksville, MO |
| O20130312000204 | MO | Part B Supplier - Clinic/Group Practice | 3274517347 |
Receives reassigned benefits from 8 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kirksville, MO |
National Provider Directory
- Tax ID family
- Kirksville Missouri Co LLC
Locations
2412 S Franklin St
Kirksville, MO 63501
Phone (660) 627-2787
630 N Morley St
Ste 107A
Moberly, MO 65270
Phone (660) 263-1819
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 462-4 | MO | Yes |
Addresses
Primary practice location
315 S Osteopathy
Kirksville, MO 63501-6401
Mailing address
PO Box 503525
Saint Louis, MO 63150-3525
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019600 | Other | FAMILY HEALTH | |
| 0537738 | Medicaid | IA | |
| 116833 | Other | HEALTHLINK | |
| 1HR81 | Other | BC MN/KS | |
| 010601201 | Medicaid | MO | |
| 032145400 | Other | BLACK LUNG | |
| 0490756 | Other | AETNA | |
| 00003296 | Other | NHC | |
| 068 | Other | WAL-MART | |
| 6350445 | Other | AETNA | |
| 10559 | Other | BCBS | |
| 132726400 | Other | DEPT OF LABOR |
Other names
- Northeast Regional Medical Center
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All providers in Kirksville, MO · General Acute Care Hospital in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.