NPIMap

Organization Active NPI

Putnam County Memorial Hospital

Doing business as Putnam County Memorial Hospital Rural Health Clinic

  • Rural Health Clinic/Center
  • Unionville, MO
National Provider Identifier
1124125539
Registry record updated Oct 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PUTNAM COUNTY MEMORIAL HOSPITAL
Doing business as
Putnam County Memorial Hospital Rural Health Clinic
Practice address
1926 Oak St
Unionville, MO 63565-1180
Phone
(660) 947-2425
Fax
(660) 947-7024
NPI assigned
Sep 20, 2006
Last updated
Oct 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2016

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

Authorized official

Name
Mrs. Rhonda Webber
Title
Accounts Payable
Phone
(660) 947-2411

Specialties & licenses 1

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

Addresses

Primary practice location

1926 Oak St
Unionville, MO 63565-1180

Mailing address

1926 Oak St
PO Box 389
Unionville, MO 63565-1180
Phone (660) 947-2425

Other names 1

  • Putnam County Memorial Hospital Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060327000726 MO Part B Supplier - Clinic/Group Practice 7911915327 Receives reassigned benefits from 11 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Unionville, MO
O20100205000669 MO Part A Provider - Rural Health Clinic 7911915327 Practice locations: Unionville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124125539. Details of each certification follow.

Rural health clinic certification: CCN 263495

Legal name
PUTNAM COUNTY MEMORIAL HOSPITAL
Doing business as
PUTNAM COUNTY MEMORIAL HOSPITAL RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 10, 1996
Last certification
Oct 13, 2021
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1926 Oak St
Unionville, MO 63565-1180
Related CCNs
261305

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0906273Putnam County Rural Health Clinic1926 Oak Street, Unionville, MO 63565Provider-performed microscopyMar 19, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/putnamm-2b5c1bdb

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Howard Luscan Individual Corporate DirectorBoard of Trustees President Nov 1, 2018
Nathan L Baughman Individual Corporate Officer Oct 23, 2017
Corporate Director Oct 23, 2017
W-2 Managing Employee Oct 23, 2017
Lindsy L Peck Individual W-2 Managing Employee Oct 1, 2014
Operational/Managerial Control Oct 1, 2014
Joetta Hunt Individual Corporate DirectorBoard of Trustees Secretary Nov 1, 2018
Linda Valentine Individual Corporate DirectorBoard of Trustees Member Nov 1, 2018
Rhonda Webber Individual W-2 Managing Employee Feb 22, 2018
Putnam County Memorial Hospital Organization, Unionville, MO Non-profit Other Aug 1, 2000
Arlene G Pickens Individual Corporate Officer Oct 23, 2017
Corporate Director Oct 23, 2017
W-2 Managing Employee Oct 23, 2017

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Putnam County Memorial HospitalUnionville, MO, CCN 261305 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2000
Aug 1, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477008000000",
    "number": "1124125539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 OAK ST",
            "address_2": "PO BOX 389",
            "city": "UNIONVILLE",
            "state": "MO",
            "postal_code": "635651180",
            "telephone_number": "660-947-2425",
            "fax_number": "660-947-7024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1926 OAK ST",
            "city": "UNIONVILLE",
            "state": "MO",
            "postal_code": "635651180",
            "telephone_number": "660-947-2425",
            "fax_number": "660-947-7024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUTNAM COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-10-21",
        "status": "A",
        "authorized_official_last_name": "WEBBER",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "ACCOUNTS PAYABLE",
        "authorized_official_telephone_number": "660-947-2411",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam County Memorial Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Unionville, MO

Sources for this page

Verify at the official NPI Registry.