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Organization Active NPI

Mercy Hospital Perry

Doing business as Mercy Hospital Perry - RHC IV

  • Rural Health Clinic/Center
  • Perryville, MO
National Provider Identifier
1336828565
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL PERRY
Doing business as
Mercy Hospital Perry - RHC IV
Practice address
210 Hospital LN
Perryville, MO 63775-1276
Phone
(573) 517-0999
Fax
(573) 517-0812
NPI assigned
Jul 14, 2023
Last updated
Oct 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Authorized official

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

Specialties & licenses 2

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

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 1

  • MERCY HOSPITAL PERRY - RHC IV Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336828565. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 21, 2023 in MO
Enrollment address
210 Hospital LN
Ste 202
Perryville, MO 63775-4200
Related CCNs
261311

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).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Perry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

212 Hospital Ln
Ste 101A
Perryville, MO 63775
Phone (573) 547-7888

212 Hospital Ln
Ste 201
Perryville, MO 63775
Phone (573) 547-4026

Ownership & related parties

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 DirectorBoard Member Oct 1, 2023
Daniel S Eckenfels Individual Corporate DirectorBoard Member Oct 1, 2023
Gregory Unger Individual Corporate DirectorBoard Member Oct 1, 2023
Robin Simms Individual Corporate DirectorBoard Member Oct 1, 2023
Sandeep C Rao Individual Corporate DirectorBoard Member Oct 1, 2023
Christopher Wibbenmeyer Individual Corporate OfficerPresident Oct 1, 2023
W-2 Managing EmployeeAdministrator Oct 1, 2023
Matthew D Gaeta Individual Corporate DirectorBoard Member Oct 1, 2023
Cheryl L Matejka Individual Operational/Managerial ControlSVP-Cfo Oct 1, 2023
Linda Buerck Individual Corporate DirectorBoard Member Oct 1, 2023
Christie Eckhardt Individual Corporate OfficerSecretary 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 DirectorChairman Oct 1, 2023
Ryan E Johnston Individual Corporate DirectorBoard Member Oct 1, 2023
Kay Taylor Individual Corporate DirectorBoard 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 DirectorBoard Member Oct 1, 2023
Patrick Naeger Individual Corporate DirectorBoard Member Oct 1, 2023
Sherry Clouse Day Individual Corporate OfficerTreasurer Oct 1, 2023

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 116

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

View all 116

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2023 Change of OwnershipThis provider was the buyer Perry County Specialty ServicesCCN 268763, MO, NPI 1720505894

Change of ownership 1

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.