NPIMap

Organization Active NPI

Kirksville Missouri Hospital Company, LLC

Doing business as Northeast Regional Medical Center

  • General Acute Care Hospital
  • Kirksville, MO
National Provider Identifier
1104899442
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
462-4 Issued in MO
Legal business name
KIRKSVILLE MISSOURI HOSPITAL COMPANY, LLC
Doing business as
Northeast Regional Medical Center
Practice address
315 S Osteopathy
Kirksville, MO 63501-6401
Phone
(660) 785-1000
NPI assigned
Feb 8, 2006
Last updated
Apr 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

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

Authorized official

Name
Paula M Lalor
Title
Director/Delegated Official
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 462-4 MO Primary

Addresses

Primary practice location

315 S Osteopathy
Kirksville, MO 63501-6401

Mailing address

PO Box 503525
Saint Louis, MO 63150-3525

Other names 1

  • Northeast Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104899442. Details of each certification follow.

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
LLCProprietary
Enrollment address
315 S Osteopathy Ave
Kirksville, MO 63501-6401
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Northeast Regional Medical CenterCCN 260022 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Northeast Regional Medi5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kevin J Hammons Individual Corporate OfficerPresident/Board Member Feb 27, 2012
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Jul 15, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Mar 2, 2012 100%
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Feb 1, 2011 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Kirksville Hospital Company, LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2007 98.7%
Paula M Lalor Individual Corporate DirectorDirector/Delegated Official Apr 1, 2017
Patrick Avila Individual W-2 Managing EmployeeCeo Sep 11, 2022
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Community Health Investment Company LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2007 100%
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 1, 2017
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Mar 2, 2012 100%

Facilities with the same owner 120

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

View all 120

Practitioners & affiliated clinicians

Practitioners 65

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 65

Affiliated clinicians 212

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

View all 212

NPI Registry JSON

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617840000000",
    "number": "1104899442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 503525",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631503525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S OSTEOPATHY",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635016401",
            "telephone_number": "660-785-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRKSVILLE MISSOURI HOSPITAL COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MO",
            "license": "462-4",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.