NPIMap

Organization Active NPI

Missouri Baptist Hospital of Sullivan

  • Critical Access Hospital
  • Sullivan, MO
National Provider Identifier
1295743169
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Practice address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone
(573) 468-4186
Fax
(573) 860-2696
NPI assigned
Aug 4, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Tony Schwarm II
Title
President
Phone
(573) 468-1343

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X NU
General Acute Care Hospital 282N00000X 355-24 MO
Critical Access Hospital 282NC0060X NU Primary
Ambulance 341600000X NU
Registered Nurse 163W00000X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

751 Sappington Bridge Rd
Sullivan, MO 63080-2354

Mailing address

751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone (573) 468-1343

Other identifiers 9

IdentifierTypeStateIssuer
800565004MedicaidMO
260115OtherPREMIER PLUS
CE7443OtherMOMEDICARE RAILROAD
108OtherBLUE CHOICE
CG2664OtherMOMEDICARE RAILROAD
MI010565000MedicaidMO
108OtherBLUE CROSS-BLUE SHIELD
489665OtherAETNA
540565009MedicaidMO

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
O20060410000616 MO Part B Supplier - Clinic/Group Practice 2668380148 Receives reassigned benefits from 71 practitioners
2 other NPIs on this enrollment
Practice locations: Sullivan, MO
O20111215000300 MO Part A Provider - Critical Access Hospital 2668380148 1 other NPI on this enrollment
Practice locations: Sullivan, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295743169. Details of each certification follow.

Hospital certification: CCN 261337

Legal name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
MISSOURI BAPTIST SULLIVAN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2012
Last certification
May 18, 2023
Beds
50
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Main/Primary Hospital Location

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 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Missouri Baptist Sullivan HospitalCCN 261337 · All quality measures
Overall star rating
2 of 5
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

Member of 1

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

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 ControlBoard Member Jan 1, 2004
Michele McKee Individual Corporate OfficerVice President, Finance Apr 1, 2026
Operational/Managerial ControlVice President, Finance Apr 1, 2026
Thomas J Jackson Individual Corporate DirectorChief Medical Officer Jan 1, 2021
Operational/Managerial ControlChief Medical Officer Jan 1, 2021
Tanya Voss Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Missouri Baptist Medical Center Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Oct 15, 2002
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 Oct 24, 2002
Operational/Managerial ControlBoard Member Jan 1, 2003
Brittni Garden Individual Corporate DirectorBoard Member Jan 1, 2025
Carmen Bartolotta Individual Corporate OfficerBoard Secretary 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 DirectorChief of Staff Jan 1, 2023
Operational/Managerial ControlChief of Staff Jan 1, 2023
BJC Health System Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Sep 1, 2012

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 3

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
Sullivan Medical OfficeSullivan, MO, CCN 263487 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 3

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

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Practitioners 74

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 74

Affiliated clinicians 149

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

View all 149

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1295743169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "573-468-1343",
            "fax_number": "573-860-2696"
        },
        {
            "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",
            "fax_number": "573-860-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI BAPTIST HOSPITAL OF SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "SCHWARM",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-468-1343",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MO",
            "license": "355-24",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800565004",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER PLUS",
            "identifier": "260115",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CE7443",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "108",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG2664",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MI010565000",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS-BLUE SHIELD",
            "identifier": "108",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "489665",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540565009",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "751 Sappington Bridge Rd",
            "city": "Sullivan",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630802354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.