NPIMap

Organization Active NPI

Mercy Hospital Ozark

  • Critical Access Hospital
  • Ozark, AR
National Provider Identifier
1275504128
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
AR3777 Issued in AR
Legal business name
MERCY HOSPITAL OZARK
Practice address
801 W River St
Ozark, AR 72949-3023
Phone
(479) 314-6100
NPI assigned
Jan 30, 2006
Last updated
Feb 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 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
Critical Access Hospital 282NC0060X AR3777 AR Primary

Addresses

Primary practice location

801 W River St
Ozark, AR 72949-3023

Mailing address

7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone (479) 314-6100

Other identifiers 4

IdentifierTypeStateIssuer
11303OtherARBLUE CROSS BLUE SHIELD
100698850AMedicaidOK
1275504128MedicaidMO
102232105MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211001144 AR Part B Supplier - Clinic/Group Practice 3678467412 Receives reassigned benefits from 144 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ozark, AR
O20040428001328 AR Part A Provider - Critical Access Hospital 3678467412 Receives reassigned benefits from 108 practitioners
Practice locations: Ozark, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275504128. Details of each certification follow.

Hospital certification: CCN 041303

Legal name
MERCY HOSPITAL OZARK
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2000
Last certification
Jan 12, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 9, 1990 in AR
Enrollment address
801 W River St
Ozark, AR 72949-3023
Other Hospital Practice Location

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).

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Hospital OzarkCCN 041303 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Ozark2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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.

Locations

7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600

801 W River St
Ozark, AR 72949
Phone (479) 667-4138

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, Fort Smith, AR Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 12, 2007 100%
Ryan Gehrig Individual Corporate OfficerPresident Apr 10, 2012
Elizabeth Maddox Individual Corporate DirectorBoard Member Jul 1, 2024
Yogya Regmi Individual W-2 Managing EmployeeDirector 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 Nov 12, 2007 100%
Martha Ullrich Individual Corporate DirectorBoard Member Jul 1, 2021
Allen Ray Individual Corporate DirectorBoard Member Jul 1, 2024
Mercy Health Organization, Chesterfield, MO Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Nov 24, 2007 100%
Carol Corley Individual Corporate DirectorBoard Member Jul 1, 2021
Judith Marie Keith Individual Corporate Director 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 Nov 1, 2020

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 153

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 153

Affiliated clinicians 74

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

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1275504128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034100",
            "telephone_number": "479-314-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W RIVER ST",
            "city": "OZARK",
            "state": "AR",
            "postal_code": "729493023",
            "telephone_number": "479-314-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL OZARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "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": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AR",
            "license": "AR3777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "11303",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100698850A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275504128",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102232105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozark, AR

Sources for this page

Verify at the official NPI Registry.