NPIMap

Mercy Hospital Perry

Organization Active NPI Rural Health Clinic/Center · Perryville, MO

NPI 1336828565 · NPPES record last updated Oct 25, 2023

Key facts

NPI
1336828565
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MERCY HOSPITAL PERRY
Practice address
210 Hospital LN
Perryville, MO 63775-1276
Phone
(573) 517-0999
Fax
(573) 517-0812
NPI assigned
Jul 14, 2023
Organization subpart
No

Authorized official

Name
Sherry Clouse Day
Title
VP-Finance Mercy Cah
Phone
(417) 820-8439

Owners & managing parties with NPI records 2

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 1

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

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

Change of ownership 1

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

Facilities with the same owner 116

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

View all 116

Practitioners 121

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 121

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Rural health clinic certification: CCN 268763

Legal name
MERCY HOSPITAL PERRY
Doing business as
MERCY HOSPITAL PERRY - RHC IV
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2017
Last certification
Jan 25, 2022
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Mar 21, 2023 in MO
Enrollment address
210 Hospital LN
Ste 202
Perryville, MO 63775-4200
Related CCNs
261311

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Gary Schumer
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Daniel S Eckenfels
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Gregory Unger
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Robin Simms
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Sandeep C Rao
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Christopher Wibbenmeyer
Individual 		Corporate Officer
President		 Oct 1, 2023
W-2 Managing Employee
Administrator		 Oct 1, 2023
Matthew D Gaeta
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Cheryl L Matejka
Individual 		Operational/Managerial Control
SVP-Cfo		 Oct 1, 2023
Linda Buerck
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Christie Eckhardt
Individual 		Corporate Officer
Secretary		 Oct 1, 2023
Stacie Farnam
Individual 		W-2 Managing Employee Oct 1, 2023
Mercy Health
Organization · Chesterfield, MO
Non-profit 		5% Or Greater Indirect Ownership Interest Oct 1, 2023 100%
Craig Hayden
Individual 		Corporate Director
Chairman		 Oct 1, 2023
Ryan E Johnston
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Kay Taylor
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Mercy Health East Communities
Organization · Saint Louis, MO
Non-profit 		5% Or Greater Direct Ownership Interest Oct 1, 2023 100%
Robert a Patrick
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Patrick Naeger
Individual 		Corporate Director
Board Member		 Oct 1, 2023
Sherry Clouse Day
Individual 		Corporate Officer
Treasurer		 Oct 1, 2023

Change-of-ownership history

DateEventCounterparty
Oct 1, 2023 Change of Ownership
This provider was the buyer		 Perry County Specialty Services
CCN 268763 · MO · NPI 1720505894

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20231101001515 MO Part B Supplier - Clinic/Group Practice 1153777826 Receives reassigned benefits from 194 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Perryville, MO
O20231102003465 MO Part a Provider - Rural Health Clinic 1153777826 Practice locations: Perryville, MO

National Provider Directory

Tax ID family
Mercy Hospital Perry (2 organizations share this tax ID)

Locations

210 Hospital Ln
Ste 202
Perryville, MO 63775
Phone (573) 517-0999

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

210 Hospital LN
Perryville, MO 63775-1276

Mailing address

210 Hospital LN Ste 202
Perryville, MO 63775-4200
Phone (573) 517-0999

Other names

  • MERCY HOSPITAL PERRY - RHC IV Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 25, 2023.

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698192000000",
    "number": "1336828565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HOSPITAL LN STE 202",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637754200",
            "telephone_number": "573-517-0999",
            "fax_number": "573-519-5329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HOSPITAL LN",
            "city": "PERRYVILLE",
            "state": "MO",
            "postal_code": "637751276",
            "telephone_number": "573-517-0999",
            "fax_number": "573-517-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL PERRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "VP-FINANCE MERCY CAH",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HOSPITAL PERRY - RHC IV",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MERCY HOSPITAL PERRY - RHC IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Perryville, MO

All providers in Perryville, MO · Rural Health Clinic/Center in Missouri

Sources for this page

Verify at the official NPI Registry.