NPIMap

Organization Active NPI

Hannibal Regional Healthcare System, Inc

Doing business as Hannibal Regional Medical Group

  • Multi-Specialty Clinic/Center
  • Hannibal, MO
National Provider Identifier
1134311392
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Doing business as
Hannibal Regional Medical Group
Practice address
6500 Hospital Drive
Hannibal, MO 63401-1239
Phone
(573) 248-1300
Fax
(573) 248-5448
NPI assigned
Aug 13, 2007
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Rob Gasaway
Title
VP of Finance
Phone
(573) 406-1608

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier 335V00000X

Addresses

Primary practice location

6500 Hospital Drive
Hannibal, MO 63401-1239

Mailing address

PO Box 1239
Hannibal, MO 63401-1239
Phone (573) 248-1300

Other identifiers 1

IdentifierTypeStateIssuer
507544203MedicaidMO

Other names 1

  • Hannibal Regional Medical Group Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071004000422 MO Part B Supplier - Clinic/Group Practice 1254236300 Receives reassigned benefits from 148 practitioners
1 other NPI on this enrollment
Practice locations: Kirksville, MO; La Plata, MO; Lancaster, MO; Louisiana, MO; Hannibal, MO; Macon, MO; Moberly, MO; Monroe City, MO…
O20200519000362 MO Part B Supplier - Portable X-Ray Supplier 1254236300 Practice locations: Hannibal, MO

Other NPIs with the same Medicare PAC ID 15

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

View all 15

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

Locations

210 N 7th St
Canton, MO 63435
Phone (573) 248-3811

6500 Hospital Dr
Ste 3A
Hannibal, MO 63401
Phone (573) 629-3500

1811 S Main St
Palmyra, MO 63461
Phone (573) 769-2231

Ownership & related parties

All facility ownership & control disclosures 13

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

FacilityTypeRoleSince
Hannibal Regional HospitalHannibal, MO, CCN 260025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Inpatient RehabilitationHannibal, MO, CCN 26T025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Hospital Home Health AgencyHannibal, MO, CCN 267282 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 22, 2012
Feb 6, 2017
Monroe City Family PracticeMonroe City, MO, CCN 268513 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Shelbina Family PracticeShelbina, MO, CCN 268512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Canton-Lagrange Family PracticeCanton, MO, CCN 263984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 3, 1992
Apr 30, 1992
Pike Medical ClinicLouisiana, MO, CCN 268723 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical Group-Bowling GreenBowling Green, MO, CCN 268724 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical GroupHannibal, MO, CCN 268754 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016
Express Care at WalmartHannibal, MO, CCN 268759 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 1, 2016
Oct 1, 2012
Complete Family Medicine Lancaster RHCLancaster, MO, CCN 268757 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine la Plata RHCLa Plata, MO, CCN 268756 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine Kirksville RHCKirksville, MO, CCN 268758 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017

Owned or controlled facilities with NPI records 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 182

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 182

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1134311392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1239",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634011239",
            "telephone_number": "573-248-1300",
            "fax_number": "573-248-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 HOSPITAL DRIVE",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634011239",
            "telephone_number": "573-248-1300",
            "fax_number": "573-248-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "GASAWAY",
        "authorized_official_first_name": "ROB",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "573-406-1608"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "507544203",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannibal Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hannibal Regional Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hannibal, MO

Sources for this page

Verify at the official NPI Registry.