NPIMap

Organization Active NPI

Phelps County Regional Medical Center

Doing business as Phelps Health

  • Rehabilitation Hospital Unit
  • Rolla, MO
National Provider Identifier
1346287455
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
14-48 Issued in MO
Legal business name
PHELPS COUNTY REGIONAL MEDICAL CENTER
Doing business as
Phelps Health
Practice address
1000 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 458-8899
NPI assigned
May 31, 2006
Last updated
Sep 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
PHELPS COUNTY REGIONAL MEDICAL CENTER OUTPATIENT PHARMACYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Jason Shenefield
Title
Ceo
Phone
(573) 458-7975

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 14-48 MO Primary

Addresses

Primary practice location

1000 W 10TH St
Rolla, MO 65401-2905

Mailing address

PO Box 220
Rolla, MO 65402-0220
Phone (573) 458-8899

Other identifiers 1

IdentifierTypeStateIssuer
010419109MedicaidMO

Other names 1

  • Phelps Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080128000067 MO Part A Provider - Hospital 2860391158 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint James, MO; Waynesville, MO; Salem, MO; Rolla, MO
O20080128000243 MO Part A Provider - Hospital 2860391158 Practice locations: Rolla, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1346287455. Details of each certification follow.

Hospital certification: CCN 260017

Legal name
PHELPS COUNTY REGIONAL MEDICAL CENTER
Doing business as
PHELPS HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 9, 2003
Beds
240 (229 certified)
Ownership / control type
Local
Organization structure
OtherNon-profit
Enrollment address
1000 W 10TH St
Rolla, MO 65401-2905
Main/Primary Hospital Location
Hospital subgroups
Acute care

Hospital certification: CCN 26T017

Legal name
PHELPS COUNTY REGIONAL MEDICAL CENTER
Doing business as
PHELPS HEALTH
Organization structure
OtherNon-profit
Enrollment address
1000 W 10TH St
Rolla, MO 65401-2905
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Phelps County Regional Medical CenterCCN 260017 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Phelps County Regional Med CenterCCN 26T017 · All quality measures
Ownership
Government
Certified
Jan 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
The Center Clinic10 organizations share this tax ID, including this one
Part of
The Center Clinic

Other organizations with this tax ID 9

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

Locations

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Phelps County Clerk Organization, Rolla, MO Operational/Managerial Control Nov 12, 2007
Operational/Managerial Control Oct 29, 2014
Ben Tipton Individual Corporate DirectorBoard Member Non-Paid Apr 1, 2024
Corporate DirectorDirector Apr 26, 2024
Jason Shenefield Individual Corporate OfficerCeo Jul 21, 2021
W-2 Managing EmployeeCeo Jul 21, 2021
Richard Elgin Individual Corporate DirectorBoard Member Non-Paid Apr 1, 2024
Corporate DirectorDirector Apr 26, 2024
Brittany Roth Individual Corporate DirectorDirector, Contracting & Enrollment Aug 26, 2022
W-2 Managing EmployeeDirector, Contracting & Enrollment Aug 26, 2022
Jana M Cook Individual Corporate OfficerSr VP - Cfo Mar 7, 2014
W-2 Managing EmployeeInterim Cfo Jan 1, 2016
Corporate OfficerSr VP / Cfo Mar 7, 2014
W-2 Managing EmployeeSr VP / Cfo Jan 1, 2016
Janece Martin Individual Corporate DirectorBoard Member Non Paid May 6, 2022
Corporate DirectorDirector Apr 15, 2022
Mary V. Graham Individual Corporate DirectorBoard Member- Non Paid Apr 23, 2026
Corporate DirectorDirector Apr 23, 2026
Annie Bass Individual Corporate DirectorBoard Member- Not Paid Apr 1, 2021
Corporate DirectorBoard Member Apr 1, 2021
Keri Heavin Individual W-2 Managing EmployeeSr VP / Chief Nursing Officer Jan 1, 2016
W-2 Managing EmployeeSr VP / Chief Nursing Officer Mar 7, 2014
Kimberley Bruno Individual W-2 Managing EmployeeAvp Revenue Cycle Sep 1, 2022

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 3

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

FacilityTypeRoleSince
Phelps Health Home Health & HospiceRolla, MO, CCN 267555 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jun 11, 1998
Phelps Health Home Health & HospiceRolla, MO, CCN 261583 Hospice 5% Or Greater Direct Ownership Interest (100%) Jun 11, 1998
Phelps Health Medical Group ViennaVienna, MO, CCN 268908 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) May 1, 2007

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 6

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 373

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

View all 373

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1346287455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654020220",
            "telephone_number": "573-458-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012905",
            "telephone_number": "573-458-8899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHELPS COUNTY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHELPS COUNTY REGIONAL MEDICAL CENTER OUTPATIENT PHARMACY",
        "enumeration_date": "2006-05-31",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "SHENEFIELD",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-458-7975"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MO",
            "license": "14-48",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010419109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phelps Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.