NPIMap

Organization Active NPI

Lauderdale Community Hospital LLC

Doing business as Lauderdale Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Ripley, TN
National Provider Identifier
1356973663
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
LAUDERDALE COMMUNITY HOSPITAL LLC
Doing business as
Lauderdale Community Hospital
Practice address
340 Asbury Ave
Ripley, TN 38063-5577
Phone
(731) 221-2200
Fax
(731) 221-2499
NPI assigned
Feb 5, 2020
Last updated
Jun 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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

Authorized official

Name
Darrel Morris
Title
Coo
Phone
(918) 527-1234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

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 1

  • Lauderdale Community Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1356973663. Details of each certification follow.

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
LLCProprietary
Incorporated
Feb 4, 2020 in TN
Enrollment address
340 Asbury Ave
Ripley, TN 38063-5577
Main/Primary Hospital Location

Hospital certification: CCN 44Z314

Legal name
LAUDERDALE COMMUNITY HOSPITAL LLC
Doing business as
LAUDERDALE COMMUNITY HOSPITAL
Organization structure
LLCProprietary
Incorporated
Feb 4, 2020 in TN
Enrollment address
340 Asbury Ave
Ripley, TN 38063-5577
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Lauderdale Community HospitalCCN 441314 · All quality measures
Type
Critical Access Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1251 NW Briarcliff Pkwy
Ste 215
Kansas City, MO 64116

340 Asbury Ave
Ripley, TN 38063
Phone (731) 221-2200

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/lauderd-6f671ec9

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
Stone Bank Organization, Little Rock, AR Financial institution 5% Or Greater Security Interest Jan 1, 2021 93.75%
5% Or Greater Security Interest Jan 1, 2021
Darrel W Morris Individual 5% Or Greater Indirect Ownership InterestChief Operating Officer Jan 1, 2021 16.22%
Corporate OfficerChief Operating Officer Jan 1, 2021 16.22%
Corporate DirectorChief Operating Officer Jan 1, 2021 16.22%
Operational/Managerial ControlChief Operating Officer Jan 1, 2021 16.22%
RHG Consolidated LLC Organization, Kansas City, MO LLC, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Phyllis Shaffer Individual 5% Or Greater Indirect Ownership Interest Dec 5, 2024 6.08%
Lawrence J Arthur Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021 16.67%
Trent M Skaggs Individual 5% Or Greater Indirect Ownership InterestCeo Jan 1, 2021 16.67%
Corporate OfficerCeo Jan 1, 2021 16.67%
Corporate DirectorCeo Jan 1, 2021 16.67%
Operational/Managerial ControlCeo Jan 1, 2021 16.67%
LG Medical LLC Organization, Kansas City, MO LLC 5% Or Greater Indirect Ownership Interest Jan 1, 2021 12.97%
Brent Lagergren Individual 5% Or Greater Indirect Ownership InterestChief Compliance Officer Jan 1, 2021 6.09%
Corporate OfficerChief Compliance Officer Jan 1, 2021 6.09%
Billy W May Individual 5% Or Greater Indirect Ownership InterestRegional VP Jan 1, 2021 5.63%
Corporate OfficerRegional VP Jan 1, 2021 5.63%
Corporate DirectorRegional VP Jan 1, 2021 5.63%
Operational/Managerial ControlRegional VP Jan 1, 2021 5.63%
Dennis L Davis Individual 5% Or Greater Indirect Ownership Interest Oct 1, 2021 16.67%
5% Or Greater Indirect Ownership Interest Jan 1, 2021 16.67%
Paul Guastello Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2021 12.97%

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

Affiliated clinicians 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718928000000",
    "number": "1356973663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 ASBURY AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380635577",
            "telephone_number": "731-221-2200",
            "fax_number": "731-221-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 ASBURY AVE",
            "city": "RIPLEY",
            "state": "TN",
            "postal_code": "380635577",
            "telephone_number": "731-221-2200",
            "fax_number": "731-221-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUDERDALE COMMUNITY HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-05",
        "last_updated": "2024-06-21",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "918-527-1234"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lauderdale Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lauderdale Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ripley, TN

Sources for this page

Verify at the official NPI Registry.