NPIMap

Organization Active NPI

Mercy Hospitals East Communities

Doing business as Mercy Hospital Washington McAuley Clinic

  • Rural Health Clinic/Center
  • Washington, MO
National Provider Identifier
1104912997
Registry record updated Feb 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITALS EAST COMMUNITIES
Doing business as
Mercy Hospital Washington McAuley Clinic
Practice address
851 E 5TH St
Suite 200
Washington, MO 63090-3129
Phone
(636) 239-8000
NPI assigned
Oct 5, 2006
Last updated
Feb 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2021

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

Authorized official

Name
Mark Thorn
Title
Executive Director Finance
Phone
(636) 528-8551

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X
Dentist 122300000X
Family Medicine Physician 207Q00000X
Obstetrics & Gynecology Physician 207V00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

851 E 5TH St
Suite 200
Washington, MO 63090-3129

Mailing address

851 E 5TH St
Suite 200
Washington, MO 63090-3129
Phone (636) 239-8000

Other identifiers 1

IdentifierTypeStateIssuer
590636908MedicaidMO

Other names 1

  • MERCY HOSPITAL WASHINGTON MCAULEY CLINIC Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040224001164 MO Part B Supplier - Clinic/Group Practice 3779479019 Receives reassigned benefits from 181 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Troy, MO; Washington, MO
O20041019000757 MO Part B Supplier - Clinic/Group Practice 3779479019 Receives reassigned benefits from 23 practitioners
Practice locations: Washington, MO
O20140103000936 MO Part A Provider - Rural Health Clinic 3779479019 Practice locations: Washington, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104912997. Details of each certification follow.

Rural health clinic certification: CCN 268545

Legal name
MERCY HOSPITALS EAST COMMUNITIES
Doing business as
MERCY HOSPITAL WASHINGTON MCAULEY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 10, 2002
Last certification
Jan 5, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
851 E 5TH St
Washington, MO 63090-3135
Related CCNs
260052

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

20 The Legends Pkwy
Ste 110
Eureka, MO 63025
Phone (636) 549-0100

1326 S Service Rd W
#40
Sullivan, MO 63080
Phone (573) 468-1320

1713 Heritage Hills Dr
Washington, MO 63090
Phone (636) 239-8858

851 E 5th St
Ste 100
Washington, MO 63090
Phone (636) 239-8258

851 E 5th St
Ste 144
Washington, MO 63090
Phone (636) 239-1770

851 E 5th St
Ste 148
Washington, MO 63090
Phone (363) 239-8840

851 E 5th St
Ste 154
Washington, MO 63090
Phone (314) 251-6663

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Cabrini Koelsch Individual Corporate Director Jul 1, 2021
John P Maroney Individual Corporate DirectorBoard Member Dec 31, 2018
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Gary Dumontier Individual Corporate DirectorBoard Member Dec 31, 2018
Kurt Voss Individual Corporate Director Jan 17, 2013
Scott Breckenkamp Individual Corporate DirectorBoard Member Jul 1, 2023
Mark a Thorn Individual Corporate Director Jun 1, 2020
W-2 Managing EmployeeExecutive Director of Finance Jun 1, 2020
Tammy Watz Individual Corporate DirectorBoard Member Jul 1, 2020
Gretchen E Farmer Individual Corporate DirectorBoard Member Jul 1, 2022
Denise Scoffic Individual Corporate OfficerTreasurer Jul 1, 2022
Stacie Farnam Individual W-2 Managing EmployeeDirector Jul 8, 2022
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Oct 9, 2009 100%
Thomas B Riechers Individual Corporate Director Oct 8, 2009
David E Chalk Individual Corporate DirectorBoard Member Jan 1, 2019
L B Eckelkamp Individual Corporate DirectorBoard Member Dec 31, 2018
William L Miller Individual Corporate Director Nov 1, 2014
Sandy Lucy Individual Corporate DirectorBoard Member Jul 1, 2023
Mercy Health East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 8, 2009 100%
Brian Day Individual Corporate OfficerSenior Vice President May 5, 2025

Owners & managing parties with NPI records 4

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

Facilities with the same owner 116

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

View all 116

Practitioners & affiliated clinicians

Practitioners 209

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 209

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614470400000",
    "number": "1104912997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "address_2": "SUITE 200",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903129",
            "telephone_number": "636-239-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 E 5TH ST",
            "address_2": "SUITE 200",
            "city": "WASHINGTON",
            "state": "MO",
            "postal_code": "630903129",
            "telephone_number": "636-239-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITALS EAST COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-02-28",
        "certification_date": "2021-02-28",
        "status": "A",
        "authorized_official_last_name": "THORN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR FINANCE",
        "authorized_official_telephone_number": "636-528-8551"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590636908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HOSPITAL WASHINGTON MCAULEY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MERCY HOSPITAL WASHINGTON MCAULEY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, MO

Sources for this page

Verify at the official NPI Registry.