NPIMap

Organization Active NPI

Missouri Baptist Hospital of Sullivan

Doing business as Sullivan Medical Office

  • Rural Health Clinic/Center
  • Sullivan, MO
National Provider Identifier
1235228222
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
355-24 Issued in MO
Legal business name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
Sullivan Medical Office
Practice address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone
(573) 468-4186
NPI assigned
Oct 11, 2006
Last updated
Sep 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Authorized official

Name
Lisa Lynne Lochner
Title
President
Phone
(573) 860-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 355-24 MO Primary

Addresses

Primary practice location

751 Sappington Bridge Rd
Sullivan, MO 63080-2354

Mailing address

670 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644

Other practice location 1

965 Mattox Dr
Sullivan, MO 63080-2365
Phone (573) 486-4186

Other identifiers 2

IdentifierTypeStateIssuer
CE7443OtherMOMEDICARE RAILROAD
CG2664OtherMOMEDICARE RAILROAD

Other names 1

  • Sullivan Medical Office Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051205000387 MO Part A Provider - Rural Health Clinic 2668380148 Practice locations: Sullivan, MO
O20060410000616 MO Part B Supplier - Clinic/Group Practice 2668380148 Receives reassigned benefits from 71 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sullivan, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235228222. Details of each certification follow.

Rural health clinic certification: CCN 263487

Legal name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
SULLIVAN MEDICAL OFFICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 3, 1996
Last certification
Jan 4, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
965 Mattox Dr
Sullivan, MO 63080-2365
Related CCNs
261337

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

240 College St
Bourbon, MO 65441
Phone (573) 732-5004

101 Ozark Dr Ste B
Cuba, MO 65453

102 Ozark Dr
Cuba, MO 65453
Phone (573) 885-6600

501 W Main St
Steelville, MO 65565

1780 Old Highway 50 E
Ste 102
Union, MO 63084
Phone (636) 583-1611

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Jennifer Fernando Barbin Individual Corporate OfficerChief of Staff Jan 1, 2025
Corporate DirectorChief of Staff Jan 1, 2025
Debbie Dixon Individual Corporate DirectorBoard Member Jan 1, 2004
Operational/Managerial Control Jan 1, 2004
Thomas J Jackson Individual Corporate DirectorChief of Staff Jan 1, 2021
Operational/Managerial ControlChief of Staff Jan 1, 2021
Missouri Baptist Hospital of Sullivan Organization, Sullivan, MO Non-profit Operational/Managerial Control Jun 2, 1994
Tanya Voss Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Missouri Baptist Medical Center Organization, Town and Country, MO Non-profit Operational/Managerial Control Jun 2, 1994
BJC Health System Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jun 2, 1994
Kelly King Individual Corporate DirectorBoard Member Jan 1, 2026
Trisha M Lollo Individual Corporate OfficerBoard Member Jan 1, 2026
Sharon Dace Individual Corporate DirectorBoard Member Jan 1, 2003
Operational/Managerial ControlBoard Member Jan 1, 2003
Brittni Garden Individual Corporate DirectorBoard Member Jan 1, 2025
Carmen Bartolotta Individual Corporate OfficerSecretary Jan 1, 2025
Jennifer Aven Individual Corporate DirectorBoard Member Jan 1, 2025
Irene Ruble Individual Corporate OfficerSecretary Nov 1, 1998
Corporate DirectorSecretary Nov 1, 1998
Operational/Managerial ControlSecretary Nov 1, 1998
Lisa Lochner Individual Corporate Officer Aug 19, 2021
W-2 Managing Employee Feb 1, 1994
Operational/Managerial Control Feb 1, 1994
Scott Hawig Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Joan Magruder Individual Corporate DirectorBoard Member Jan 1, 2023
Operational/Managerial ControlBoard Member Jan 1, 2023

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Missouri Baptist Cuba Medical OfficeCuba, MO, CCN 263407 Rural health clinic Operational/Managerial Control Jun 2, 1994
Missouri Baptist Steelville OfficeSteelville, MO, CCN 268528 Rural health clinic Operational/Managerial Control Jun 2, 1994

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 39

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

View all 39

Practitioners & affiliated clinicians

Practitioners 98

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 98

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758067200000",
    "number": "1235228222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR STE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-7644",
            "fax_number": "314-996-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "573-468-4186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "965 Mattox Dr",
            "address_purpose": "LOCATION",
            "city": "Sullivan",
            "state": "MO",
            "postal_code": "630802365",
            "country_code": "US",
            "telephone_number": "573-486-4186",
            "fax_number": "314-996-3610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSOURI BAPTIST HOSPITAL OF SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A",
        "authorized_official_last_name": "LOCHNER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-860-6000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "355-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CE7443",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG2664",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "965 Mattox Dr",
            "city": "Sullivan",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630802365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sullivan Medical Office",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan Medical Office",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.