John Fitzgibbon Memorial Hospital Inc
Organization Active NPI Rural Health Clinic/Center · Fayette, MO
NPI 1316140494 · NPPES record last updated Mar 5, 2024
Key facts
- NPI
- 1316140494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 27-56 (MO)
- Legal business name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC
- Practice address
- 600 W Morrison St
Suite 5
Fayette, MO 65248-1075 - Phone
- (660) 248-2900
- Fax
- (660) 248-1544
- NPI assigned
- Jun 7, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Authorized official
- Name
- Nancy Harris
- Title
- Cfo/Coo
- Phone
- (660) 886-7231
Owners & managing parties with NPI records 16
-
Darin Lee Haug, DO
-
Jared Karl Romney, D.O.
-
Jack R Uhrig, M.D.
-
Jason E Gault, DO
Owned or controlled facilities with NPI records 14
Other NPIs on the same Medicare enrollment 12
Other NPIs with the same Medicare PAC ID 11
Related certifications (CCN) 13
Facilities with the same owner 7
Practitioners 47
-
Patricia Lynn Klinger Day, FNP-BC
-
Kurt Schroer, D.O.
-
Eric D Bettis, DO
-
David P. Brummett, M.D.
-
Kaylea Bultmann, FNP
-
Pearl Carrillo, DO
-
Yan Chen, MD, PHD
-
Karla Dora Dobbs, D.O.
-
Brenda K Dodds, RN, FNP-C, FNP
-
Deanna C Donnell, CNM
-
Mary J Drenon, FNP
-
Amber Renee Drumheller, PMHNP-BC
-
Roy J Elfrink, M.D.
-
Ann Marie Gray, M.D.
-
Darin Lee Haug, DO
-
Deborah Ann Herrmann, M.D.
-
James H Kerns, MD
-
David J Keuhn, M.D.
-
Carrie A Lucas, RN, FNP
-
Carrie M Peecher, DO
-
Wallace Eugene Ralston, CRNA
-
Jared Karl Romney, D.O.
Affiliated clinicians 130
-
Sadiat Omowunmi Adebiyi, APRN
-
Cary Dean Adkisson, F.N.P.
-
Naser Almasalmeh, M.D.
-
Scott A Anderson, D.O.
-
Abdullah Arshad, MD
-
Jonathan Mark Beary, D.O.
-
Eric D Bettis, DO
-
Brian Bostick, M.D.
-
John Kenneth Boyer, M.D.
-
Blake Jay Brooks, M.D.
-
Richard Brown, MD
-
David P. Brummett, M.D.
-
Kaylea Bultmann, FNP
-
Lynda G Carlyle, FNP
-
Pearl Carrillo, DO
-
Aruna Cheddi, M.D.
-
Yan Chen, MD, PHD
-
Logan Chronister, FNP-BC
-
Justin Robert Cramer, M.D.
-
Michael D Curry, MD, PHD
-
Patricia Lynn Klinger Day, FNP-BC
-
William E Decker, MD
Medicare Care Compare: Hospital
- Listed as
- Fitzgibbon Hospital
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in MO
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
- Corporation · Non-profit
- Enrollment address
- 2305 S Highway 65
Marshall, MO 65340-3702 - Hospital subgroups
- Acute care, Swing-bed approved, Psychiatric unit
Rural health clinic certification: CCN 268731
- Legal name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC
- Doing business as
- FITZGIBBON FAMILY HEALTH
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 8, 2016
- Last certification
- Dec 16, 2020
- Ownership / control type
- 2A
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1961 in MO
- Enrollment address
- 600 W Morrison St
Fayette, MO 65248-1471 - Related CCNs
- 260142
Rural health clinic certification: CCN 268789
- Legal name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC
- Doing business as
- MID-MISSOURI FAMILY HEALTH AT FITZGIBBON
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1961 in MO
- Enrollment address
- 2303 S Highway 65
Ste a
Marshall, MO 65340-3735
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| John Fitzgibbon Memorial Hospital Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 1966 | 100% |
| Operational/Managerial Control | Jul 1, 1966 | ||
| Operational/Managerial Control | Aug 1, 2014 | ||
| Operational/Managerial Control | Apr 1, 2020 | ||
| Jan Stapleton |
Other | Sep 22, 2015 | |
| Corporate Officer |
Sep 22, 2015 | ||
| Corporate Director |
Sep 22, 2015 | ||
| Scott Hartwig |
Other |
Sep 22, 2015 | |
| Corporate Officer |
Sep 22, 2015 | ||
| Corporate Director |
Sep 22, 2015 | ||
| Darin L Haug |
W-2 Managing Employee |
Sep 1, 2012 | |
| William L Summers |
Other |
Jan 1, 1999 | |
| Corporate Officer |
Jan 1, 1999 | ||
| Corporate Director |
Jan 1, 1999 | ||
| Mary Lou Porter |
Other | Oct 25, 2016 | |
| Corporate Director |
Oct 25, 2016 | ||
| Nancy K Harris |
Corporate Officer |
Feb 14, 2020 | |
| W-2 Managing Employee | Feb 14, 2020 | ||
| W-2 Managing Employee |
Feb 14, 2020 | ||
| Corporate Officer |
Mar 14, 2020 | ||
| Operational/Managerial Control |
Apr 1, 2020 | ||
| Angela P Littrell |
Corporate Officer |
Feb 14, 2020 | |
| W-2 Managing Employee | Jun 2, 2014 | ||
| W-2 Managing Employee |
Jun 4, 2014 | ||
| Corporate Director |
Feb 14, 2020 | ||
| Operational/Managerial Control |
Apr 1, 2020 | ||
| Jared K Romney |
Other |
May 1, 2023 | |
| Angela Igo |
W-2 Managing Employee |
Jan 1, 2016 | |
| Thomas Jones |
W-2 Managing Employee |
Feb 1, 2011 | |
| Christopher J Sporleder |
Corporate Director |
May 1, 2018 | |
| W-2 Managing Employee |
May 1, 2018 | ||
| Jack R Uhrig |
Corporate Director |
Nov 1, 2008 | |
| Jill Lilleman |
Corporate Director | Oct 25, 2016 | |
| Corporate Director |
Oct 25, 2016 | ||
| Robert Blalock |
Corporate Officer | May 29, 2018 | |
| W-2 Managing Employee | May 29, 2018 | ||
| Jason Gault |
Corporate Director |
May 1, 2021 | |
| Andrew J Snyder |
Corporate Director |
Apr 1, 2021 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Fitzgibbon Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jul 1, 1966 Jul 1, 1966 |
| Fitzgibbon Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 1, 1966 |
| The Living Center |
Skilled nursing facility | Operational/Managerial Control (10%) | Jul 5, 1995 |
| Fitzgibbon Professional Building |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 1, 1996 Jun 1, 1996 |
| Akeman McBurney Health Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
May 16, 2012 Nov 1, 2010 |
| Mid-Missouri Family Health at Fitzgibbon |
Rural health clinic | Operational/Managerial Control | Apr 1, 2020 |
| Pilot Grove Medical Clinic at Fitzgibbon |
Rural health clinic | Operational/Managerial Control | Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
| O20080708000234 | MO | Part B Supplier - Clinic/Group Practice | 2567351570 |
Receives reassigned benefits from 16 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fayette, MO; Marshall, MO |
| O20150806011729 | MO | Part a Provider - Rural Health Clinic | 2567351570 | Practice locations: Fayette, MO |
| O20210608002462 | MO | Part a Provider - Rural Health Clinic | 2567351570 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marshall, MO |
National Provider Directory
- Part of
- Marshall Surgical Assoc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | MO | ||
| Rural Health Clinic/Center | 261QR1300X | 27-56 | MO | Yes |
Addresses
Primary practice location
600 W Morrison St
Suite 5
Fayette, MO 65248-1075
Mailing address
2305 S Highway 65
Marshall, MO 65340-3702
Phone (660) 886-7431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 503959108 | Medicaid | MO |
Other names
- Fitzgibbon Family Health
Other providers in Fayette, MO
- Howard County Home Health and Hospice
- Howard County Home Health and Hospice
- Howard County Home Health and Hospice
- Howard County Sheltered Services Board
- Jordan Jenkins
- Just What the Doctor Ordered
- Jacob Ryan Kent
- Teresa Maxine Kircher
- Christina Corinne Kirkendoll
- Paden G. Kleinhesselink
All providers in Fayette, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.