NPIMap

Organization Active NPI

Hannibal Regional Healthcare System, Inc

Doing business as Hospice of Northeast Missouri

  • Community Based Hospice Care Agency
  • Kirksville, MO
National Provider Identifier
1316452295
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Doing business as
Hospice of Northeast Missouri
Practice address
201 S Baltimore St Ste C
Kirksville, MO 63501-3736
Phone
(606) 279-7116
NPI assigned
Dec 13, 2017
Last updated
Jan 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Authorized official

Name
Robert N Gasaway
Title
Cfo
Phone
(573) 248-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

201 S Baltimore St Ste C
Kirksville, MO 63501-3736

Mailing address

6500 Hospital Dr
Hannibal, MO 63401-6890
Phone (573) 248-1300

Other names 1

  • Hospice of Northeast Missouri Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220412000393 MO Part A Provider - Hospice 1254236300 Practice locations: Kirksville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316452295. Details of each certification follow.

Hospice certification: CCN 261557

Legal name
HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Doing business as
HOSPICE OF NORTHEAST MISSOURI
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 14, 1995
Last certification
Apr 8, 2021
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Aug 6, 1965 in MO
Enrollment address
201 S Baltimore St
Ste C
Kirksville, MO 63501-3736

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Northeast MissouriCCN 261557 · All quality measures
Ownership
Non-Profit
Certified
Mar 14, 1995
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hannibal Regional Healt33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Carolyn Shaw Individual Corporate DirectorBoard of Directors Member, Chair Jan 1, 2002
Michael Holliday Individual Corporate DirectorBoard of Directors Member Jan 1, 2020
Bradley Kurz Individual Corporate DirectorBoard of Directors Member Jan 1, 2018
Jason Poage Individual Corporate DirectorBoard of Directors Member, Treas Jan 1, 2013
Robert N Gasaway Individual Corporate OfficerVP of Finance Feb 6, 2017
W-2 Managing EmployeeVP of Finance Feb 6, 2017
Operational/Managerial ControlVP of Finance Feb 6, 2017
Robert D Floyd Individual W-2 Managing EmployeeMD; Jan 1, 2022
Christopher T Ahrens Individual Corporate OfficerPresident and Ceo Dec 26, 2006
W-2 Managing EmployeePresident and Ceo Jan 1, 2022
Operational/Managerial ControlPresident and Ceo Dec 26, 2006

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 13

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hannibal Regional HospitalHannibal, MO, CCN 260025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Inpatient RehabilitationHannibal, MO, CCN 26T025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Hospital Home Health AgencyHannibal, MO, CCN 267282 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 22, 2012
Feb 6, 2017
Monroe City Family PracticeMonroe City, MO, CCN 268513 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Shelbina Family PracticeShelbina, MO, CCN 268512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Canton-Lagrange Family PracticeCanton, MO, CCN 263984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 3, 1992
Apr 30, 1992
Pike Medical ClinicLouisiana, MO, CCN 268723 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical Group-Bowling GreenBowling Green, MO, CCN 268724 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical GroupHannibal, MO, CCN 268754 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016
Express Care at WalmartHannibal, MO, CCN 268759 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 1, 2016
Oct 1, 2012
Complete Family Medicine Lancaster RHCLancaster, MO, CCN 268757 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine la Plata RHCLa Plata, MO, CCN 268756 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine Kirksville RHCKirksville, MO, CCN 268758 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017

Owned or controlled facilities with NPI records 13

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

View all 13

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2022 Change of OwnershipThis provider was the buyer Hospice of Northeast MissouriCCN 261557, MO, NPI 1497746234

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 10

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

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1316452295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6500 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016890",
            "telephone_number": "573-248-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S BALTIMORE ST STE C",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013736",
            "telephone_number": "606-279-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A",
        "authorized_official_last_name": "GASAWAY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-248-1300"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Northeast Missouri",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirksville, MO

Sources for this page

Verify at the official NPI Registry.