NPIMap

Organization Active NPI

Mercy Health-Lourdes Hospital LLC

  • General Acute Care Hospital
  • Paducah, KY
National Provider Identifier
1346244126
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
100304 Issued in KY
Legal business name
MERCY HEALTH-LOURDES HOSPITAL LLC
Practice address
1530 Lone Oak Rd
Paducah, KY 42003-7901
Phone
(270) 444-2163
Fax
(270) 444-2460
NPI assigned
Jun 9, 2005
Last updated
Mar 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Authorized official

Name
Mr. Michael Yungmann
Title
Ceo
Phone
(270) 444-2491

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 100304 KY Primary
Certified Registered Nurse Anesthetist 367500000X 20A KY
Certified Registered Nurse Anesthetist 367500000X 2489A KY

Addresses

Primary practice location

1530 Lone Oak Rd
Paducah, KY 42003-7901

Mailing address

PO Box 636545
Cincinnati, OH 45263-6545
Phone (270) 444-2163

Other identifiers 1

IdentifierTypeStateIssuer
01012152MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other BLUEMARK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040209001113 KY Part B Supplier - Clinic/Group Practice 7315831666 Receives reassigned benefits from 14 practitioners
6 other NPIs on this enrollment
Practice locations: Benton, KY
O20060618000004 KY Part A Provider - Hospital 7315831666 1 other NPI on this enrollment
Practice locations: Benton, KY; Paducah, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346244126. Details of each certification follow.

Hospital certification: CCN 180102

Legal name
MERCY HEALTH-LOURDES HOSPITAL LLC
Doing business as
MERCY HEALTH-LOURDES HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 28, 2002
Beds
359
Ownership / control type
Church
Organization structure
LLCNon-profit
Incorporated
Sep 26, 1962 in KY
Enrollment address
1530 Lone Oak Rd
Paducah, KY 42003-7901
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric, Rehabilitation

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 7

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Health - Lourdes HospitalCCN 180102 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

225 Medical Center Dr
Ste 205
Paducah, KY 42003
Phone (270) 441-4462

3125 Parisa Dr
Paducah, KY 42003
Phone (270) 575-0080

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Staci Averill Individual Corporate DirectorBoard Member Jan 1, 2021
David Culbertson Individual Corporate DirectorBoard Member Aug 1, 2017
Justin Dixon Individual Corporate DirectorBoard Member Oct 1, 2016
Timothy J Ranval Individual Corporate DirectorBoard Member Jan 1, 2024
Glenn Denton Individual Corporate DirectorBoard Member Jan 1, 2020
Charles Bohle Individual Corporate DirectorBoard Member Aug 1, 2010
Shonda Hollowell-Burrus Individual Corporate DirectorBoard Member Jan 1, 2022
Michael J Yungmann Individual Corporate OfficerRegional Ceo Jan 9, 2017
Corporate DirectorBoard Member Jan 9, 2017
W-2 Managing EmployeeRegional Ceo Jan 9, 2017
Kevin R Kauffeld Individual Corporate DirectorBoard Member Jan 1, 2025
Michael Bezney Individual Corporate DirectorBoard Member Jan 1, 2023
Brian Yanofchick Individual Corporate DirectorBoard Member Jan 1, 2023
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Angel Davis-Reed Individual Corporate DirectorBoard Member Jan 1, 2023
John Starcher Individual Operational/Managerial ControlChain Home Office Admin Jan 1, 2016
James H Long Individual Corporate DirectorBoard Member Aug 1, 2017
Cindy Erickson Individual Corporate DirectorBoard Member Jan 1, 2023
Ethan Witt Individual Corporate DirectorBoard Member Jan 1, 2025
Caroline Korte Individual Corporate DirectorBoard Member Feb 1, 2014
Roger Harris Individual Corporate DirectorBoard Member Jan 1, 2025
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Oct 7, 2017

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Mercy Health-Marcum and Wallace HospitalIrvine, KY, CCN 181301 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 13, 2000
Mercy Health-Marcum & Wallace Hospital LLCIrvine, KY, CCN 18Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 13, 2000
Mercy Health - Irvine Primary CareIrvine, KY, CCN 183462 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jul 1, 2010
Mercy Health - Powell County Primary CareClay City, KY, CCN 183475 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Sep 1, 2012

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 97

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

View all 97

Practitioners & affiliated clinicians

Practitioners 44

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 44

Affiliated clinicians 422

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

View all 422

NPI Registry JSON

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1346244126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636545",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636545",
            "telephone_number": "270-444-2163",
            "fax_number": "270-444-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 LONE OAK RD",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037901",
            "telephone_number": "270-444-2163",
            "fax_number": "270-444-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH-LOURDES HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "YUNGMANN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-444-2491",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "KY",
            "license": "100304",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "20A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "2489A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01012152",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "BLUEMARK",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

Verify at the official NPI Registry.