Lauderdale Community Hospital LLC
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Ripley, TN
NPI 1356973663 · NPPES record last updated Jun 21, 2024
Key facts
- NPI
- 1356973663
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- LAUDERDALE COMMUNITY HOSPITAL LLC
- Practice address
- 340 Asbury Ave
Ripley, TN 38063-5577 - Phone
- (731) 221-2200
- Fax
- (731) 221-2499
- NPI assigned
- Feb 5, 2020
- Organization subpart
- No
Authorized official
- Name
- Darrel Morris
- Title
- Coo
- Phone
- (918) 527-1234
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 11
Practitioners 46
-
Andi Marie Anderson, CRNA
-
Bryan Clifford Anderson, DNAP
-
Douglas Lee Campbell, M.D.
-
Wayne Darrell Murray, M.D.
-
William Matthew Tosh, D.O.
-
David Mulvaney, M.D.
-
Toby Allen Penner, CRNA, MSN
-
Naji Bourji, M.D.
-
Colton Hunter Brown, CRNA
-
James A Caylor, MD
-
Candice G Freeman, CRNA
-
Renee C Hubbard, DO
-
William A. James, M.D.
-
Sharon K Lucus, CRNA
-
Gabriel C Nold, DO
-
Simon Olalekan Okewole, D.O.
-
Folarin Olatunji, FNP-BC
-
Nirav Patel, M.D.
Affiliated clinicians 39
-
Faris Al-Gebory, M.D.
-
Andi Marie Anderson, CRNA
-
Bryan Clifford Anderson, DNAP
-
Naji Bourji, M.D.
-
Samuel Lee Broffitt, M.D.
-
Douglas Lee Campbell, M.D.
-
Kristen Deaton, PMHNP-BC
-
Madelyne Ellis, FNP
-
Omar O Hamze, M.D.
-
Joe W Hunt, MD
-
William A. James, M.D.
-
L David Johnson, MD
-
Mark Allen Jones, MD
-
Karen Louise Martin, FNP
-
Cynthia M. Mashburn, APRN, BC, FNP
-
Jordan Nicole McNeil, FNP-BC
Medicare Care Compare: Hospital
- Listed as
- Lauderdale Community Hospital
- Type
- Critical Access Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Hospital certification: CCN 441314
- Legal name
- LAUDERDALE COMMUNITY HOSPITAL LLC
- Doing business as
- LAUDERDALE COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Oct 1, 2005
- Last certification
- Nov 20, 2025
- Beds
- 25
- Ownership / control type
- Private (for profit)
- Most recent change of ownership
- Apr 1, 2010 (1 total)
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 4, 2020 in TN
- Enrollment address
- 340 Asbury Ave
Ripley, TN 38063-5577
Hospital certification: CCN 44Z314
- Legal name
- LAUDERDALE COMMUNITY HOSPITAL LLC
- Doing business as
- LAUDERDALE COMMUNITY HOSPITAL
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 4, 2020 in TN
- Enrollment address
- 340 Asbury Ave
Ripley, TN 38063-5577
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Stone Bank |
5% Or Greater Security Interest | Jan 1, 2021 | 93.75% |
| 5% Or Greater Security Interest | Jan 1, 2021 | ||
| Darrel W Morris |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2021 | 16.22% |
| Corporate Officer |
Jan 1, 2021 | 16.22% | |
| Corporate Director |
Jan 1, 2021 | 16.22% | |
| Operational/Managerial Control |
Jan 1, 2021 | 16.22% | |
| RHG Consolidated LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2021 | 100% |
| Phyllis Shaffer |
5% Or Greater Indirect Ownership Interest | Dec 5, 2024 | 6.08% |
| Lawrence J Arthur |
5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 16.67% |
| Trent M Skaggs |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2021 | 16.67% |
| Corporate Officer |
Jan 1, 2021 | 16.67% | |
| Corporate Director |
Jan 1, 2021 | 16.67% | |
| Operational/Managerial Control |
Jan 1, 2021 | 16.67% | |
| LG Medical LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 12.97% |
| Brent Lagergren |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2021 | 6.09% |
| Corporate Officer |
Jan 1, 2021 | 6.09% | |
| Billy W May |
5% Or Greater Indirect Ownership Interest |
Jan 1, 2021 | 5.63% |
| Corporate Officer |
Jan 1, 2021 | 5.63% | |
| Corporate Director |
Jan 1, 2021 | 5.63% | |
| Operational/Managerial Control |
Jan 1, 2021 | 5.63% | |
| Dennis L Davis |
5% Or Greater Indirect Ownership Interest | Oct 1, 2021 | 16.67% |
| 5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 16.67% | |
| Paul Guastello |
5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 12.97% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210507000505 | TN | Part a Provider - Critical Access Hospital | 9830505023 |
Receives reassigned benefits from 33 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Ripley, TN |
| O20220913004217 | TN | Part a Provider - Critical Access Hospital | 9830505023 | Practice locations: Ripley, TN |
National Provider Directory
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/lauderd-6f671ec9
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | Yes |
Addresses
Primary practice location
340 Asbury Ave
Ripley, TN 38063-5577
Mailing address
340 Asbury Ave
Ripley, TN 38063-5577
Phone (731) 221-2200
Other names
- Lauderdale Community Hospital
Other providers in Ripley, TN
- Patti Cagle Jones
- Samuel David Keeton
- Tamara A Kent
- Lauderdale Behavioral Health
- Lauderdale Community Hospital LLC
- Lauderdale Community Hospital LLC
- Lauderdale Community Hospital LLC
- Lauderdale County Ambulance Authority
- LD&H Specialized Care Services
- John David Lovely
All providers in Ripley, TN · Medicare Defined Swing Bed Hospital Unit in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.