NPIMap

Organization Active NPI

Russellville Hospital Inc.

Doing business as Russellville Hospital Swing Bed Unit

  • Medicare Defined Swing Bed Hospital Unit
  • Russellville, AL
National Provider Identifier
1114095049
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
RUSSELLVILLE HOSPITAL INC.
Doing business as
Russellville Hospital Swing Bed Unit
Practice address
15155 Highway 43
Russellville, AL 35653-1975
Phone
(256) 332-1611
Fax
(256) 332-8674
NPI assigned
Nov 30, 2006
Last updated
Aug 11, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
RUSSELLVILLE HOSPITAL INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Stephen N. Clapp
Title
President/Ceo
Phone
(865) 269-4074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

15155 Highway 43
Russellville, AL 35653-1975

Mailing address

15155 Highway 43
Russellville, AL 35653-1975
Phone (256) 332-1611

Other names 1

  • Russellville Hospital Swing Bed Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150330001567 AL Part A Provider - Hospital 3476878489 Practice locations: Russellville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114095049. Details of each certification follow.

Hospital certification: CCN 01U158

Legal name
RUSSELLVILLE HOSPITAL INC.
Doing business as
RUSSELLVILLE HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 2014 in TN
Enrollment address
15155 Hwy 43
Russellville, AL 35653-1975
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Russellville Hospital Inc5 organizations share this tax ID, including this one
Part of
Russellville Hospital

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Java Medical Group LLC Organization, Nashville, TN LLC Operational/Managerial Control Dec 20, 2018 100%
Martha McCormick Individual Operational/Managerial ControlChief Operating Officer for Java Me Dec 20, 2018 13.33%
Ashoke Mukherji Individual Operational/Managerial ControlChief Executive Officer Java Medica Dec 20, 2018 53.34%
Gregory S Cheatham Individual Operational/Managerial ControlChief Medical Officer for Java Medi Dec 20, 2018 33.33%
The Dava Foundation Inc Organization, Manchester, TN Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 20, 2018 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1114095049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15155 HIGHWAY 43",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531975",
            "telephone_number": "256-332-1611",
            "fax_number": "256-332-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15155 HIGHWAY 43",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531975",
            "telephone_number": "256-332-1611",
            "fax_number": "256-332-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE HOSPITAL INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUSSELLVILLE HOSPITAL INC.",
        "enumeration_date": "2006-11-30",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "CLAPP",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "865-269-4074"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russellville Hospital Swing Bed Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AL

Sources for this page

Verify at the official NPI Registry.