NPIMap

Organization Active NPI

Advance Hannibal Regional Hospital, LLC

  • Physical Therapist
  • Hannibal, MO
National Provider Identifier
1124364138
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ADVANCE HANNIBAL REGIONAL HOSPITAL, LLC
Practice address
188 Medical Drive
Hannibal, MO 63401
Phone
(573) 400-6057
NPI assigned
Dec 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Mr. Gregory Reis, P.T.
Title
Partner
Phone
(217) 222-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

188 Medical Drive
Hannibal, MO 63401

Mailing address

160 Progress Rd Ste 111
Hannibal, MO 63401-6630
Phone (573) 406-0576

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131021000862 MO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6709022122 Receives reassigned benefits from 30 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bowling Green, MO; Canton, MO; Hannibal, MO; Kirksville, MO; Monroe City, MO; Palmyra, MO; Troy, MO

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Advance Hannibal Regional Hospital LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

1804 Elm St
Canton, MO 63435
Phone (573) 288-3311

188 Medical Dr
Hannibal, MO 63401
Phone (314) 248-1010

188A Medical Dr
Ste A
Hannibal, MO 63401

188 Medical Dr
#A
Hannibal, MO 63401
Phone (573) 406-0576

1605 S Baltimore St
Ste C
Kirksville, MO 63501
Phone (573) 406-1371

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1124364138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 PROGRESS RD STE 111",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016630",
            "telephone_number": "573-406-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 MEDICAL DRIVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "63401",
            "telephone_number": "573-400-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE HANNIBAL REGIONAL HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "REIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "217-222-6800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.