NPIMap

Organization Active NPI

New Liberty Hospital Corporation

Doing business as The Plattsburg Clinic

  • Rural Health Clinic/Center
  • Plattsburg, MO
National Provider Identifier
1154053833
Registry record updated Jun 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NEW LIBERTY HOSPITAL CORPORATION
Doing business as
The Plattsburg Clinic
Practice address
400 W Clay Ave
Plattsburg, MO 64477-1424
Phone
(816) 415-3460
Fax
(816) 415-3461
NPI assigned
Jun 30, 2022
Last updated
Jun 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2022

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

Authorized official

Name
Michael Leone
Title
Cfo
Phone
(816) 781-7200

Specialties & licenses 1

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

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 1

  • The Plattsburg Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241202003695 MO Part A Provider - Rural Health Clinic 9931166618 Practice locations: Plattsburg, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154053833. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
400 W Clay Ave
Plattsburg, MO 64477-1424

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
New Liberty Hospital Corporation14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Elizabeth Carlton Individual Corporate DirectorBoard Member Jul 1, 2024
Jessica Rhodus Individual W-2 Managing EmployeeDirector, Patient Financial Service Jul 1, 2022
John a Staton Individual W-2 Managing EmployeeCoo Apr 2, 2023
Kirstie S Van Ry Individual Corporate DirectorBoard Member Jul 1, 2024
Sherri L Vaughn Individual Corporate DirectorBoard Member Jul 1, 2024
Raghavendra B. Adiga Individual Corporate OfficerCeo Jul 1, 2024
Corporate DirectorBoard Member Jul 1, 2024
Catherine R Wiens Individual W-2 Managing EmployeeChief Compliance Officer Jul 1, 2024
Daniel Peters Individual Corporate OfficerSecretary Jul 1, 2024
Corporate DirectorBoard Member Jul 1, 2024
Douglas Gaston Individual Corporate OfficerTreasurer Jul 1, 2024
Sheila Feekes Individual W-2 Managing EmployeeAd; Jul 1, 2022
Robert K Page Individual Corporate OfficerPresident Jul 1, 2024
Chakshu Gupta Individual Corporate DirectorBoard Member Jul 1, 2024
University of Kansas Hospital Authority Organization, Kansas City, KS Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2024 100%

Owners & managing parties with NPI records 15

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

View all 15

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Change-of-ownership history 1

DateEventCounterparty
Jun 30, 2022 Change of OwnershipThis provider was the buyer Plattsburg Medical ClinicCCN 263929, MO, NPI 1376568121

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656547200000",
    "number": "1154053833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W CLAY AVE",
            "city": "PLATTSBURG",
            "state": "MO",
            "postal_code": "644771424",
            "telephone_number": "816-415-3460",
            "fax_number": "816-415-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W CLAY AVE",
            "city": "PLATTSBURG",
            "state": "MO",
            "postal_code": "644771424",
            "telephone_number": "816-415-3460",
            "fax_number": "816-415-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIBERTY HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "LEONE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "816-781-7200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Plattsburg Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plattsburg, MO

Sources for this page

Verify at the official NPI Registry.