NPIMap

Organization Active NPI

Pcrmc Medical Group, Inc

Doing business as Phelps Health Medical Group Rolla

  • Clinic/Center
  • Rolla, MO
National Provider Identifier
1124237227
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PCRMC MEDICAL GROUP, INC
Doing business as
Phelps Health Medical Group Rolla
Practice address
1050 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 364-9000
Fax
(573) 458-3952
NPI assigned
May 22, 2007
Last updated
Mar 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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

Authorized official

Name
Jana M Cook
Title
VP, Chief Financial Officer
Phone
(573) 458-7916

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1050 W 10TH St
Rolla, MO 65401-2905

Mailing address

PO Box 579
Rolla, MO 65402-0579
Phone (573) 426-2182

Other practice location 1

1000 W 10th St
Rolla, MO 65401-2905
Phone (573) 364-9000

Other practice location 2

603 S Bishop Ave
Rolla, MO 65401-4320
Phone (573) 426-4411

Other practice location 3

1428 E State Hwy 72
Rolla, MO 65401-3988
Phone (573) 364-1014

Other practice location 4

35629 Highway 72
Salem, MO 65560-7217
Phone (855) 406-3324

Other practice location 5

1415 W Scenic Rivers Blvd
Salem, MO 65560-2840
Phone (573) 729-5533

Other practice location 6

1000 N Jefferson St
Saint James, MO 65559-1078
Phone (573) 265-8840

Other practice location 7

1060 W 10th St
Rolla, MO 65401-2905
Phone (855) 406-3324

Other practice location 8

600 Blues Lake Pkwy
Rolla, MO 65401-8022
Phone (573) 364-8822

Other practice location 9

1201 Hauck Dr
Rolla, MO 65401-4900
Phone (573) 364-8818

Other practice location 10

1000 Gw Ln
Waynesville, MO 65583-2339
Phone (573) 774-2715

Other practice location 11

1422 S Sam Houston Blvd
Houston, MO 65483-2130
Phone (573) 364-9000

Other identifiers 2

IdentifierTypeStateIssuer
507013605MedicaidMO
591072301MedicaidMO

Other names 1

  • Phelps Health Medical Group Rolla Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070829000437 MO Part B Supplier - Clinic/Group Practice 1557454063 Receives reassigned benefits from 142 practitioners
2 other NPIs on this enrollment
Practice locations: Waynesville, MO; Vienna, MO; St James, MO; Salem, MO; Saint James, MO; Rolla, MO; Houston, MO
O20100701000579 MO Part A Provider - Rural Health Clinic 1557454063 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vienna, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124237227. Details of each certification follow.

Rural health clinic certification: CCN 268908

Legal name
PCRMC MEDICAL GROUP INC
Doing business as
PHELPS HEALTH MEDICAL GROUP VIENNA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 4, 2010
Last certification
Oct 4, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
606 Highway 63 S
Ste a
Vienna, MO 65582-8101

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 2

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

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Ste 380
Rolla, MO 65401

1050 W 10th St
Ste 400
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Ste 550
Rolla, MO 65401
Phone (573) 364-7545

1050 W 10th St
Ste 580
Rolla, MO 65401
Phone (573) 426-6239

1428 E State Route 72
Rolla, MO 65401
Phone (573) 364-1014

1501 E 10th St
Ste B
Rolla, MO 65401
Phone (573) 341-0139

35629 Highway 72
Bldg 1
Salem, MO 65560
Phone (573) 729-2050

35629 Highway 72
Bldg 2
Salem, MO 65560

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Ben Tipton Individual Corporate OfficerDirector Apr 26, 2024
Jason Shenefield Individual Corporate OfficerCeo Jul 22, 2021
Corporate DirectorCeo Jul 22, 2021
W-2 Managing EmployeeCeo Jul 22, 2021
Richard Elgin Individual Corporate DirectorDirector Apr 1, 2023
Kimberley Bruno Individual Corporate OfficerAssociate VP of Revenue Cycle Aug 26, 2022
W-2 Managing EmployeeAssociate VP of Revenue Cycle Aug 26, 2022
Brittany Roth Individual Corporate DirectorDirector, Contracting & Enrollment Jul 11, 2022
W-2 Managing EmployeeDirector, Contracting & Enrollment Jul 11, 2022
Jana M Cook Individual Corporate OfficerCfo Jul 31, 2021
Corporate DirectorCfo Jul 31, 2021
W-2 Managing EmployeeCfo Jul 31, 2021
Phelps County Regional Medical Center Organization, Rolla, MO Non-profit 5% Or Greater Direct Ownership Interest May 1, 2007 100%
Janece Martin Individual Corporate DirectorDirector May 6, 2022
Mary V. Graham Individual Corporate DirectorDirector Apr 23, 2026
Annie Bass Individual Corporate OfficerBoard Member May 6, 2022

Owners & managing parties with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 149

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 149

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772409600000",
    "number": "1124237227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 579",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654020579",
            "telephone_number": "573-426-2182",
            "fax_number": "573-426-5341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-364-9000",
            "fax_number": "573-458-3952"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "603 S Bishop Ave",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654014320",
            "country_code": "US",
            "telephone_number": "573-426-4411",
            "fax_number": "573-426-4403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1428 E State Hwy 72",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654013988",
            "country_code": "US",
            "telephone_number": "573-364-1014",
            "fax_number": "573-364-6872",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "35629 Highway 72",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MO",
            "postal_code": "655607217",
            "country_code": "US",
            "telephone_number": "855-406-3324",
            "fax_number": "573-458-8363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1415 W Scenic Rivers Blvd",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MO",
            "postal_code": "655602840",
            "country_code": "US",
            "telephone_number": "573-729-5533",
            "fax_number": "573-202-2466",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 N Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Saint James",
            "state": "MO",
            "postal_code": "655591078",
            "country_code": "US",
            "telephone_number": "573-265-8840",
            "fax_number": "573-202-2474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1060 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654012905",
            "country_code": "US",
            "telephone_number": "855-406-3324",
            "fax_number": "573-458-8363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Blues Lake Pkwy",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654018022",
            "country_code": "US",
            "telephone_number": "573-364-8822",
            "fax_number": "573-202-2402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Hauck Dr",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "654014900",
            "country_code": "US",
            "telephone_number": "573-364-8818",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Gw Ln",
            "address_purpose": "LOCATION",
            "city": "Waynesville",
            "state": "MO",
            "postal_code": "655832339",
            "country_code": "US",
            "telephone_number": "573-774-2715",
            "fax_number": "573-202-2410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1422 S Sam Houston Blvd",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "MO",
            "postal_code": "654832130",
            "country_code": "US",
            "telephone_number": "573-364-9000",
            "fax_number": "573-426-2108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PCRMC MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JANA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-458-7916"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507013605",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "591072301",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phelps Health Medical Group Rolla",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.