NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc

Doing business as Fitzgibbon Mental Health

  • Psychiatry Physician
  • Marshall, MO
National Provider Identifier
1285779330
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
27-57 Issued in MO
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
Fitzgibbon Mental Health
Practice address
2305 South 65 Highway, Building a
Marshall, MO 65340-3702
Phone
(660) 886-7800
NPI assigned
Feb 20, 2007
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHN FITZGIBBON MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7231

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Psychiatry Physician 2084P0800X 27-57 MO Primary

Addresses

Primary practice location

2305 South 65 Highway, Building a
Marshall, MO 65340-3702

Mailing address

2305 South 65 Highway, Building a
Marshall, MO 65340-3702
Phone (660) 886-7800

Other identifiers 2

IdentifierTypeStateIssuer
268577OtherMOMEDICARE
1285779330MedicaidMO

Other names 1

  • Fitzgibbon Mental Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000980 MO Part B Supplier - Clinic/Group Practice 2567351570 Receives reassigned benefits from 68 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, MO; Pilot Grove, MO
O20080104000462 MO Part A Provider - Hospital 2567351570 11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brunswick, MO; Fayette, MO; Marshall, MO; Pilot Grove, MO; Slater, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285779330. Details of each certification follow.

Hospital certification: CCN 260142

Legal name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
FITZGIBBON HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 13, 2023
Beds
60
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
2305 S Highway 65
Marshall, MO 65340-3702
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved, Psychiatric unit

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

Care Compare: Hospital

Medicare Care Compare
Listed as
Fitzgibbon HospitalCCN 260142 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Eastwood Family Clinic

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Fitzgibbon Memorial Hospital Inc Organization, Marshall, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Operational/Managerial Control Jul 1, 1966
Jan Stapleton Individual Other Sep 22, 2015
Scott Hartwig Individual OtherSecretary Sep 22, 2015
Darin L Haug Individual W-2 Managing EmployeeCmo Sep 1, 2012
William L Summers Individual OtherPresident Jan 1, 1999
Mary Lou Porter Individual Other Oct 25, 2016
Nancy K Harris Individual Corporate OfficerCfo Feb 14, 2020
W-2 Managing Employee Feb 14, 2020
Angela P Littrell Individual Corporate OfficerPresident & Ceo Feb 14, 2020
W-2 Managing Employee Jun 2, 2014
Jared K Romney Individual OtherPresident of Medical Staff May 1, 2023
Angela Igo Individual W-2 Managing EmployeeCno Jan 1, 2016
Thomas Jones Individual W-2 Managing EmployeeCio Feb 1, 2011

Owners & managing parties with NPI records 14

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

View all 14

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 130

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

View all 130

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1285779330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY, BUILDING A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY, BUILDING A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2007-02-20",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7231"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MO",
            "license": "27-57",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "268577",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285779330",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitzgibbon Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fitzgibbon Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.