NPIMap

Organization Active NPI

Ste Genevieve County Memorial Hospital

  • Rural Health Clinic/Center
  • Bloomsdale, MO
National Provider Identifier
1184658387
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Practice address
255 Boderman
Bloomsdale, MO 63627-9099
Phone
(573) 483-9492
NPI assigned
Jul 11, 2006
Organization subpart
Yes
Parent organization
STE GENEVIEVE COUNTY MEMORIAL HOSPITALAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Amanda Wolk
Title
Business Office Director
Phone
(573) 883-7703

Owners & managing parties with NPI records 8

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

Owned or controlled facilities with NPI records 7

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 8

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

Facilities with the same owner 7

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

Practitioners 101

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

View all 101

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0989950Bloomsdale Family Health Care255 Boderman Lane, Bloomsdale, MO 63627Certificate of waiverApr 26, 2028

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040102000645 MO Part B Supplier - Clinic/Group Practice 3274432802 Receives reassigned benefits from 66 practitioners
4 other NPIs on this enrollment
Practice locations: Bloomsdale, MO; Ste Genevieve, MO
O20091006000058 MO Part A Provider - Rural Health Clinic 3274432802 Practice locations: Bloomsdale, MO

Rural health clinic certification: CCN 268647

Legal name
STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
Doing business as
BLOOMSDALE FAMILY HEALTH CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 15, 2010
Last certification
Feb 21, 2024
Ownership / control type
2A
Organization structure
GovernmentNon-profit
Enrollment address
255 Boderman
Bloomsdale, MO 63627-9099
Related CCNs
261330

Facilities connected through Provider of Services related, parent or unit certification numbers.

All disclosed owners & managing parties 5

Medicare enrollment files

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

NameRoleSinceShare
Tracy a Bonnell Individual Corporate DirectorDirector- Central Billing Office Sep 1, 2023
Rachel L Dallas Individual W-2 Managing Employee Apr 22, 2022
Amanda Wolk Individual Corporate DirectorDirector Phys Central Billing Jun 1, 2016
Ste Genevieve County Memorial Hospital Organization, Ste Genevieve, MO 5% Or Greater Direct Ownership Interest Nov 1, 2000 100%
Operational/Managerial Control Nov 1, 2000
John Schmidt Individual Corporate OfficerChief Financial Officer May 1, 2023

All facility ownership & control disclosures 7

Medicare enrollment files

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

FacilityTypeRoleSince
Ste Genevieve County Memorial HospitalSainte Genevieve, MO, CCN 261330 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1969
Ste Genevieve County Memorial HospitalSainte Genevieve, MO, CCN 26Z330 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1969
Pine Drive Medical CentreSte Genevieve, MO, CCN 263439 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 2, 2004
Apple Kids PediatricsSte Genevieve, MO, CCN 268622 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 8, 1996
Jan 8, 1997
Women'S Health CenterSte Genevieve, MO, CCN 268623 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 2, 2008
Jun 1, 2008
Family Health Care Pointe BasseSainte Genevieve, MO, CCN 268580 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2004
Apr 1, 2004
Plaza Family Health CareSte Genevieve, MO, CCN 268744 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016

National Provider Directory

National Provider Directory
Part of
Ste Genevieve Co Hospital

Locations

255 Boderman
Ste 1D
Bloomsdale, MO 63627

255 Boderman
Ste 2A
Bloomsdale, MO 63627
Phone (573) 883-4473

900 Park Dr
Sainte Genevieve, MO 63670

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

NPPES NPI Registry

Primary practice location

255 Boderman
Bloomsdale, MO 63627-9099

Mailing address

PO Box 366
Ste Genevieve, MO 63670-0366
Phone (573) 883-4477

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
CC8331OtherMORAILROAD MEDICARE

Other names 2

NPPES NPI Registry
  • Bloomsdale Family Health Care Doing business as
  • Bloomsdale Family Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 13, 2023.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1184658387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636700366",
            "telephone_number": "573-883-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 BODERMAN",
            "city": "BLOOMSDALE",
            "state": "MO",
            "postal_code": "636279099",
            "telephone_number": "573-483-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STE GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STE GENEVIEVE COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "WOLK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "573-883-7703"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC8331",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bloomsdale Family Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloomsdale Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bloomsdale Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomsdale, MO

Sources for this page

Verify at the official NPI Registry.