NPIMap

Organization Active NPI

General John J Pershing Memorial Hospital Association

Doing business as Meadville Medical Clinic

  • Rural Health Clinic/Center
  • Meadville, MO
National Provider Identifier
1285995944
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Meadville Medical Clinic
Practice address
101 E Hayward St
Meadville, MO 64659-9201
Phone
(660) 938-4213
Fax
(660) 938-4211
NPI assigned
May 30, 2012
Last updated
Nov 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Authorized official

Name
Mr. Kenneth E Baranski, CPA
Title
Cfo
Phone
(660) 258-1288

Specialties & licenses 1

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

Addresses

Primary practice location

101 E Hayward St
Meadville, MO 64659-9201

Mailing address

101 E Hayward St
PO Box 131
Meadville, MO 64659-9201
Phone (660) 938-4213

Other names 1

  • Meadville Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050422000230 MO Part B Supplier - Clinic/Group Practice 2860306750 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brookfield, MO; Meadville, MO
O20121030000308 MO Part A Provider - Rural Health Clinic 2860306750 Practice locations: Meadville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285995944. Details of each certification follow.

Rural health clinic certification: CCN 268682

Legal name
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Doing business as
MEADVILLE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 31, 2013
Last certification
Oct 2, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1955 in MO
Enrollment address
101 E Hayward St
Meadville, MO 64659-9201
Related CCNs
261307

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).

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2042634Meadville Medical Clinic101 East Hayward, Meadville, MO 64659Certificate of waiverJun 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pershing Hosp Home HLTH8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

101 E Hayward St
Meadville, MO 64659
Phone (660) 938-4213

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Kenneth E Baranski Individual Corporate DirectorCfo Board Member Jul 16, 2021
W-2 Managing EmployeeCfo Board Member Jul 16, 2021
James Elliot Individual Corporate DirectorBoard Member Jun 28, 2011
Brian L Winn Individual Corporate DirectorBoard Member May 6, 2014
Gary Routledge Individual Corporate DirectorBoard Member Jun 26, 2002
General John J Pershing Memorial Hospital Association Organization, Meadville, MO Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2012 100%
Operational/Managerial Control Jul 10, 2012 100%
Joe Smith Individual Corporate DirectorBoard Member Jun 1, 2015
Gail Turner Individual Corporate DirectorBoard Member Jun 25, 2001
William Thudium Individual Corporate DirectorBoard Member Jun 24, 1991
David R Shaw Individual Corporate DirectorBoard Member Oct 23, 2011
Kelly C Schwager Individual W-2 Managing EmployeeClinic Director Nov 1, 2021
Karla D Clubine Individual Contracted Managing EmployeeCeo Board Member Nov 1, 2021
Corporate DirectorCeo Board Member Nov 1, 2021
Karen a Sylvara Individual Corporate DirectorBoard Member Jan 1, 2022
Operational/Managerial Control Jul 10, 2012
Mark Cleveland Individual Corporate DirectorBoard Member Jun 24, 2005

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1285995944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E HAYWARD ST",
            "address_2": "PO BOX 131",
            "city": "MEADVILLE",
            "state": "MO",
            "postal_code": "646599201",
            "telephone_number": "660-938-4213",
            "fax_number": "660-938-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E HAYWARD ST",
            "city": "MEADVILLE",
            "state": "MO",
            "postal_code": "646599201",
            "telephone_number": "660-938-4213",
            "fax_number": "660-938-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-30",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "BARANSKI",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-258-1288",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Meadville Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meadville, MO

Sources for this page

Verify at the official NPI Registry.