NPIMap

Organization Active NPI

Mercy Hospital Booneville

  • Medicare Defined Swing Bed Hospital Unit
  • Booneville, AR
National Provider Identifier
1235567504
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
MERCY HOSPITAL BOONEVILLE
Practice address
880 W Main St
Booneville, AR 72927-3443
Phone
(479) 675-2800
NPI assigned
Oct 24, 2013
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Sherry Lynn Clouse Day
Title
VP Finance
Phone
(417) 820-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

880 W Main St
Booneville, AR 72927-3443

Mailing address

880 W Main St
Booneville, AR 72927-3443
Phone (479) 675-2800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140312001500 AR Part A Provider - Critical Access Hospital 1951530385 Practice locations: Booneville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235567504. Details of each certification follow.

Hospital certification: CCN 04Z318

Legal name
MERCY HOSPITAL BOONEVILLE
Organization structure
CorporationNon-profit
Incorporated
Oct 10, 2013 in AR
Enrollment address
880 W Main St
Booneville, AR 72927-3443

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Booneville4 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.

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Mercy Health Fort Smith Communities Organization, Ft Smith, AR Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%
Ryan Gehrig Individual Corporate OfficerPresident Jan 1, 2014
W-2 Managing EmployeePresident Jan 1, 2014
Elizabeth Maddox Individual Corporate DirectorBoard Member Jul 1, 2024
Yogya Regmi Individual W-2 Managing EmployeeVP Finance Aug 29, 2022
Michael Keith Gibbons Individual Corporate DirectorBoard Member Jul 1, 2022
Edward Melton Individual Corporate DirectorBoard Member Jul 1, 2024
Bret Cook Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Hospital Fort Smith Organization, Fort Smith, AR Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Martha Ullrich Individual Corporate DirectorBoard Member Jul 1, 2021
Allen Ray Individual Corporate DirectorBoard Member Jul 1, 2024
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office Operational/Managerial Control Jan 2, 2014 100%
Carol Corley Individual Corporate DirectorBoard Member Jul 1, 2021
Judith Marie Keith Individual Corporate DirectorBoard Member Jul 1, 2021
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP Finance Jan 1, 2021
Vicky Laird Individual Corporate DirectorBoard Member Jul 1, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 115

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

View all 115

Practitioners & affiliated clinicians

Practitioners 11

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.

Affiliated clinicians 1

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": "1382572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1235567504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 W MAIN ST",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729273443",
            "telephone_number": "479-675-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 W MAIN ST",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729273443",
            "telephone_number": "479-675-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL BOONEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-24",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, AR

Sources for this page

Verify at the official NPI Registry.