Phelps County Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Rolla, MO
NPI 1366066037 · NPPES record last updated Feb 1, 2023
Key facts
- NPI
- 1366066037
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PHELPS COUNTY REGIONAL MEDICAL CENTER
- Practice address
- 1050 W 10TH St
Rolla, MO 65401-2905 - Phone
- (573) 364-9000
- NPI assigned
- May 29, 2020
- Organization subpart
- No
Authorized official
- Name
- Jana Marie Cook
- Title
- Sr. VP/Cfo
- Phone
- (573) 458-7916
Owners & managing parties with NPI records 1
-
Mary V Graham, MD
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 9
Related certifications (CCN) 3
Facilities with the same owner 6
Practitioners 193
-
Nurelign G. Abebe, M.D.
-
Katie Ann Allen, RN,MSN,FNP-C
-
Steven R Ballard, ANP
-
Mahmoud Ballout, MD
-
Christopher Black, CRNA
-
Sarah Elizabeth Bolin, CRNA, DNAP
-
Elliotte Schafer Bourne, PA-C
-
Miriam Louise Brawley, FNP-C
-
Kelcie Brunnert, CRNA, DNAP
-
Melanie Cole Budnik, CRNA
-
Lisa M Burmeister, CRNA
-
Jeffrey Colench, CRNA
-
Amber Cook, NP-C
-
Jason Anthony Corey, CRNA
-
Nathan Alec Crawshaw, PA-C
-
Angela Delaria, CRNA
-
Collin Dobson, CRNA
-
Christine G Durbin, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Rural health clinic certification: CCN 268798
- Legal name
- PHELPS COUNTY REGIONAL MEDICAL CENTER
- Doing business as
- PHELPS HEALTH MEDICAL GROUP
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 1, 2023
- Last certification
- Jun 29, 2022
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 1050 W 10TH St
Rolla, MO 65401-2905 - Related CCNs
- 260017
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Phelps County Clerk |
Operational/Managerial Control | Nov 12, 2007 | |
| Ben Tipton |
Corporate Director |
Apr 26, 2024 | |
| Jason Shenefield |
Corporate Director |
Jul 22, 2021 | |
| W-2 Managing Employee |
Jul 22, 2021 | ||
| Richard Elgin |
Corporate Director |
Apr 1, 2023 | |
| Kimberley Bruno |
Corporate Director |
Aug 26, 2022 | |
| W-2 Managing Employee |
Aug 26, 2022 | ||
| Brittany Roth |
Corporate Director |
Aug 26, 2022 | |
| W-2 Managing Employee |
Aug 26, 2022 | ||
| Jana M Cook |
Corporate Director |
Jul 31, 2021 | |
| W-2 Managing Employee |
Jul 31, 2021 | ||
| Janece Martin |
Corporate Director |
May 6, 2022 | |
| Mary V. Graham |
Corporate Director |
Apr 23, 2026 | |
| Annie Bass |
Corporate Director |
May 6, 2022 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Phelps Health Home Health & Hospice |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jun 11, 1998 |
| Phelps Health Home Health & Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jun 11, 1998 |
| Phelps Health Medical Group Vienna |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040106000405 | MO | Part B Supplier - Clinic/Group Practice | 2860391158 |
Receives reassigned benefits from 184 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cuba, MO; Waynesville, MO; Vienna, MO; Sullivan, MO; St. James, MO; Salem, MO; Saint James, MO; Rolla, MO… |
| O20230303002223 | MO | Part a Provider - Rural Health Clinic | 2860391158 | Practice locations: Rolla, MO |
National Provider Directory
- Tax ID family
- Phelps County
Locations
124 Westwood Cir
Bourbon, MO 65441
Phone (573) 732-5241
1194 Landon Rd
Bourbon, MO 65441
Phone (573) 468-8150
105 N Lawrence St
Cuba, MO 65453
Phone (573) 885-1077
603 S Bishop Ave
Rolla, MO 65401
Phone (573) 426-4411
1700 E 10th St
Rolla, MO 65401
Phone (573) 364-2602
415 Sidney St
Saint James, MO 65559
Phone (573) 265-8921
1203 N Jackson St
Salem, MO 65560
Phone (573) 729-6640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1050 W 10TH St
Rolla, MO 65401-2905
Mailing address
PO Box 579
Rolla, MO 65402-0579
Phone (573) 426-2182
Other names
- Phelps Health Medical Group
Other providers in Rolla, MO
- PG Optical LLC
- Phelps County Clerk
- Phelps County Industrial Solutions Inc
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
- Phelps County Regional Medical Center
All providers in Rolla, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.