Southeast Health Center of Reynolds County LLC

Primary specialty

Critical Access HospitalTaxonomy code 282NC0060X

Legal business name

SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY LLC

Doing business as

SoutheastHEALTH Center of Reynolds County

Practice address

100 Hwy 21
Ellington, MO 63638-7943

Phone

(573) 996-2141

Fax

(573) 996-3949

NPI assigned

Jan 16, 2013

Last updated

Aug 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cheryl Barton, RN

Title

Ceo

Phone

(573) 996-2141

Specialties & licenses 1

Addresses

Other names 1

• SoutheastHEALTH Center of Reynolds County Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1356689905. Details of each certification follow.

• CCN 260229 Hospital · Terminated · Name & address match · Details
• CCN 261339 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 260229

Legal name

SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY

Certification status

Terminated Other: provider status change, Jul 2, 2015

Provider type (POS)

Hospital – Short-term

Participating since

Jul 19, 2013

Last certification

Jul 19, 2013

Beds

25

Ownership / control type

Private (not for profit)

Facility address

100 Hwy 21 N
Ellington, MO 63638

Hospital certification: CCN 261339

Legal name

SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY

Certification status

Terminated Voluntary: merger or closure, Mar 11, 2016

Provider type (POS)

Hospital – Critical access hospital

Participating since

Jul 2, 2015

Last certification

Jul 2, 2015

Beds

25

Ownership / control type

Private (not for profit)

Facility address

100 Hwy 21 N
Ellington, MO 63638

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Southeast Hospital

  dba Mercy Hospital Southeast

  • General Acute Care Hospital
  • Cape Girardeau, MO
  • NPI 1811006661

  Member Of

  NPD member

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

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471564800000",
    "number": "1356689905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 PLUM ST",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351277",
            "telephone_number": "573-996-2141",
            "fax_number": "573-996-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HWY 21",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "636387943",
            "telephone_number": "573-996-2141",
            "fax_number": "573-996-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-16",
        "last_updated": "2016-08-19",
        "status": "A",
        "authorized_official_last_name": "BARTON",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-996-2141",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SoutheastHEALTH Center of Reynolds County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul De Vries Rains, D.O.
• Iris Fae Ross, MA, L.P.C.
• Rodney T. Rubi, MD
• Jenny S. Russell
• Rebecca Rae Singleton, DMD
• Southeast Health Center of Reynolds County, LLC (SoutheastHEALTH Ellington Clinic)
• Southeast Health Center of Reynolds County, LLC (SoutheastHEALTH Family Medicine of Ellington)
• Southeast Health Center of Reynolds LLC (SoutheastHEALTH Center of Reynolds County)
• Southern Reynolds Rii
• Joyce Anne Stout

• Critical Access Hospital in Ellington, MO
• Providers in Ellington, MO by specialty
• Critical Access Hospital in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.