NPIMap

Organization Active NPI

Russellville Hospital Inc.

Doing business as Russellville Hospital

  • Rural Acute Care Hospital
  • Russellville, AL
National Provider Identifier
1316015241
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
10351 Issued in AL
Legal business name
RUSSELLVILLE HOSPITAL INC.
Doing business as
Russellville Hospital
Practice address
15155 Highway 43
Russellville, AL 35653-1975
Phone
(256) 332-1611
Fax
(256) 332-8674
NPI assigned
Nov 30, 2006
Last updated
Aug 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Stephen N. Clapp
Title
President/Ceo
Phone
(865) 269-4074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 10351 AL Primary

Addresses

Primary practice location

15155 Highway 43
Russellville, AL 35653-1975

Mailing address

15155 Highway 43
Russellville, AL 35653-1975
Phone (256) 332-1611

Other identifiers 2

IdentifierTypeStateIssuer
HOS0158HMedicaidAL
1729132MedicaidLA

Other names 1

  • Russellville Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150330001278 AL Part A Provider - Hospital 3476878489 Practice locations: Russellville, AL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316015241. Details of each certification follow.

Hospital certification: CCN 010158

Legal name
RUSSELLVILLE HOSPITAL INC.
Doing business as
RUSSELLVILLE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 1, 1998
Last certification
Oct 22, 2014
Beds
100
Ownership / control type
Private (for profit)
Most recent change of ownership
Jan 1, 2015 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 2014 in TN
Enrollment address
15155 Hwy 43
Russellville, AL 35653-1975
Other Hospital Practice Location
Hospital subgroups
General

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

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Russellville HospitalCCN 010158 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Russellville Hospital Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Java Medical Group LLC Organization, Nashville, TN LLC Operational/Managerial Control Dec 20, 2018 100%
Martha McCormick Individual Operational/Managerial ControlChief Operating Officer for Java Me Dec 20, 2018 13.33%
Ashoke Mukherji Individual Operational/Managerial ControlCeo Java Medical Group Dec 20, 2018 53.34%
Blanton Gray Individual Corporate Director Dec 20, 2018
Gregory S Cheatham Individual Operational/Managerial ControlChief Medical Officer for Java Medi Dec 20, 2018 33.33%
Mary Beth Johnson Individual Corporate Director Dec 20, 2018
The Dava Foundation Inc Organization, Manchester, TN Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 20, 2018 100%
Christine Roberts Stewart Individual W-2 Managing EmployeeCeo/Administrator Jan 1, 2015
Operational/Managerial ControlCeo/Administrator Jan 1, 2015
Joseph Clifton Chester Individual Corporate Director Dec 20, 2018

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 5

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

Practitioners & affiliated clinicians

Practitioners 5

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 77

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

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1316015241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15155 HIGHWAY 43",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531975",
            "telephone_number": "256-332-1611",
            "fax_number": "256-332-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15155 HIGHWAY 43",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356531975",
            "telephone_number": "256-332-1611",
            "fax_number": "256-332-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "CLAPP",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "865-269-4074"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "AL",
            "license": "10351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HOS0158H",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1729132",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Russellville Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AL

Sources for this page

Verify at the official NPI Registry.