New Liberty Hospital Corporation
Organization Active NPI Rural Health Clinic/Center · Plattsburg, MO
NPI 1154053833 · NPPES record last updated Jun 30, 2022
Key facts
- NPI
- 1154053833
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- NEW LIBERTY HOSPITAL CORPORATION
- Practice address
- 400 W Clay Ave
Plattsburg, MO 64477-1424 - Phone
- (816) 415-3460
- Fax
- (816) 415-3461
- NPI assigned
- Jun 30, 2022
- Organization subpart
- No
Authorized official
- Name
- Michael Leone
- Title
- Cfo
- Phone
- (816) 781-7200
Owners & managing parties with NPI records 15
-
Raghavendra B. Adiga, M.D.
-
Kirstie Schneider Van Ry, M.D.
-
Chakshu Gupta, MD
-
Sherri S. Vaughn, MD
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 13
Member of 1
Change of ownership 1
Facilities with the same owner 25
Practitioners 135
-
Asem A. Abdeljalil, M.D.
-
Raghavendra B. Adiga, M.D.
-
Neal Blakely Anson, M.D.
-
Rachel C Arrow, FNP-C
-
Adam Cole Ashby, NP
-
John Judson Barclay Jr., D.O.
-
Katlyn C Bates, APRN
-
Lori C Baughman, M.D.
-
Jane Anne Bell, M.D.
-
Stephanie Bild, FNP-C
-
Christine M Boutwell, M.D.
-
Katie Brewer, AU.D.
-
John A Burroughs, M.D.
-
Jennifer Marie Busby, APRN
-
Jodie Carpenter, NP-C
-
Madison Paige Cenkus, FNP-C
-
Imran Q Cheema, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Rural health clinic certification: CCN 263929
- Legal name
- NEW LIBERTY HOSPITAL CORPORATION
- Doing business as
- THE PLATTSBURG CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 31, 2002
- Last certification
- Nov 13, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 400 W Clay Ave
Plattsburg, MO 64477-1424
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Elizabeth Carlton |
Corporate Director |
Jul 1, 2024 | |
| Jessica Rhodus |
W-2 Managing Employee |
Jul 1, 2022 | |
| John a Staton |
W-2 Managing Employee |
Apr 2, 2023 | |
| Kirstie S Van Ry |
Corporate Director |
Jul 1, 2024 | |
| Sherri L Vaughn |
Corporate Director |
Jul 1, 2024 | |
| Raghavendra B. Adiga |
Corporate Officer |
Jul 1, 2024 | |
| Corporate Director |
Jul 1, 2024 | ||
| Catherine R Wiens |
W-2 Managing Employee |
Jul 1, 2024 | |
| Daniel Peters |
Corporate Officer |
Jul 1, 2024 | |
| Corporate Director |
Jul 1, 2024 | ||
| Douglas Gaston |
Corporate Officer |
Jul 1, 2024 | |
| Sheila Feekes |
W-2 Managing Employee |
Jul 1, 2022 | |
| Robert K Page |
Corporate Officer |
Jul 1, 2024 | |
| Chakshu Gupta |
Corporate Director |
Jul 1, 2024 | |
| University of Kansas Hospital Authority |
5% Or Greater Direct Ownership Interest | Jul 1, 2024 | 100% |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jun 30, 2022 | Change of Ownership |
Plattsburg Medical Clinic |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241202003695 | MO | Part a Provider - Rural Health Clinic | 9931166618 | Practice locations: Plattsburg, MO |
National Provider Directory
- Tax ID family
- New Liberty Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
400 W Clay Ave
Plattsburg, MO 64477-1424
Mailing address
400 W Clay Ave
Plattsburg, MO 64477-1424
Phone (816) 415-3460
Other names
- The Plattsburg Clinic
Other providers in Plattsburg, MO
- Mary Anne Kaser
- Amy R Koehn
- Missouri CVS Pharmacy, L.L.C.
- N & R of Plattsburg, LLC
- New Liberty Hospital Coporation
- New Liberty Hospital Corporation
- New Liberty Medical & Hospital Corp
- New Liberty Medical & Hospital Corporation
- Nick'S Health Care Center LLC
- Nick'S SNF Opco LLC
All providers in Plattsburg, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.