NPIMap

Organization Active NPI

Southeast Hospital

Doing business as Mercy Hospital Southeast

  • Rehabilitation Hospital Unit
  • Cape Girardeau, MO
National Provider Identifier
1194907493
Registry record updated Jan 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
80-49 Issued in MO
Legal business name
SOUTHEAST HOSPITAL
Doing business as
Mercy Hospital Southeast
Practice address
1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone
(573) 651-5500
NPI assigned
Nov 29, 2007
Last updated
Jan 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2024

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

Authorized official

Name
Krista Berry
Title
Cfo
Phone
(573) 331-6028

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 80-49 MO Primary

Addresses

Primary practice location

1701 Lacey St
Cape Girardeau, MO 63701-5230

Mailing address

1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 651-5500

Other names 1

  • MERCY HOSPITAL SOUTHEAST Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071221000316 MO Part A Provider - Hospital 7719897776 Practice locations: Cape Girardeau, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194907493. Details of each certification follow.

Hospital certification: CCN 26T110

Legal name
SOUTHEAST HOSPITAL
Doing business as
MERCY HOSPITAL SOUTHEAST
Organization structure
CorporationNon-profit
Incorporated
Sep 22, 2014 in MO
Enrollment address
1701 Lacey St
Cape Girardeau, MO 63701-5230
Hospital Rehabilitation Unit
Hospital subgroups
Acute care, Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Southeast HospitalCCN 26T110 · All quality measures
Ownership
Non-profit
Certified
Oct 1, 2001

National Provider Directory

National Provider Directory
Tax ID family
Southeast Missouri Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Andrew J Moore Individual Corporate DirectorBoard Member Aug 1, 2025
Carl E Ammons Individual Corporate DirectorDirector Aug 1, 2025
Stanley L Crader Individual Corporate OfficerTreasurer Aug 1, 2025
Steven M Green Individual Corporate DirectorDirector Aug 23, 2013
Christopher Wibbenmeyer Individual Corporate DirectorBoard Member Aug 1, 2025
Charles Kruse Individual Corporate DirectorBoard Member Aug 1, 2025
Angie Umfleet Individual Corporate DirectorChair Dec 20, 2023
Krista Berry Individual Corporate DirectorCfo Dec 20, 2023
W-2 Managing EmployeeSystems Controller Jan 1, 2016 10%
Michael Kohlfeld Individual Corporate Director Jan 1, 2002
Frank M Kinder Individual Corporate DirectorBoard Member Aug 1, 2025
Andrew Runge Individual Corporate DirectorBoard Member Aug 1, 2025
Stacie Farnam Individual W-2 Managing Employee Dec 20, 2023
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 20, 2023 100%
Benjamin F Lewis Individual Corporate Director Jan 1, 2002
Curt Buchheit Individual Corporate DirectorVice Chair Aug 1, 2025
Naresh Agarwal Individual Corporate DirectorBoard Member Aug 1, 2025
Southeasthealth System Inc Organization, Cape Girardeau, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 30, 2013 100%
Wade a Richey Individual Corporate DirectorBoard Member Aug 1, 2025
Fred Ducharme Individual Corporate DirectorBoard Member Aug 1, 2025
Mercy Health East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 20, 2023 100%
James J Dufek Individual Corporate Director Jan 1, 2002
Brian Day Individual Corporate OfficerSenior Vice President Aug 1, 2025

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Mercy Hospital StoddardDexter, MO, CCN 260160 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardDexter, MO, CCN 26U160 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Southeast Behavioral HospitalCape Girardeau, MO, CCN 264034 Hospital 5% Or Greater Direct Ownership Interest (25%) Aug 5, 2020
Mercy Southeast Primary Care WestCape Girardeau, MO, CCN 268657 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2001
Mercy Southeast PediatricsCape Girardeau, MO, CCN 268674 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2006
Mercy Hospital StoddardDexter, MO, CCN 268658 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardDexter, MO, CCN 268570 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardMalden, MO, CCN 268661 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardBloomfield, MO, CCN 268587 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardBernie, MO, CCN 268683 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardSikeston, MO, CCN 268768 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardNew Madrid, MO, CCN 268777 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jul 2, 2019

Owned or controlled facilities with NPI records 12

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

Facilities with the same owner 116

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

View all 116

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705104000000",
    "number": "1194907493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-651-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-651-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-29",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-6028"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MO",
            "license": "80-49",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HOSPITAL SOUTHEAST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.