NPIMap

Organization Active NPI

Lutheran Home for the Aged

  • Skilled Nursing Facility
  • Cape Girardeau, MO
National Provider Identifier
1376539320
Registry record updated Sep 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
030491 Issued in MO
Legal business name
LUTHERAN HOME FOR THE AGED
Practice address
2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335
Phone
(573) 335-0158
Fax
(573) 986-6312
NPI assigned
Sep 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2025

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

Authorized official

Name
Jackie S Payne
Title
Cfo
Phone
(573) 335-0158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 030491 MO Primary

Addresses

Primary practice location

2825 Bloomfield Rd
Cape Girardeau, MO 63703-6335

Mailing address

2825 Bloomfield Rd
Cape Girardeau, MO 63703-6398
Phone (573) 335-0158

Other identifiers 6

IdentifierTypeStateIssuer
102445400MedicaidMO
588585505MedicaidMO
288861503MedicaidMO
262445406MedicaidMO
268861507MedicaidMO
292924008MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100308000414 MO Part A Provider - Skilled Nursing Facility 4385630318 Practice locations: Cape Girardeau, MO

Skilled nursing facility certification: CCN 265359

Legal name
LUTHERAN HOME FOR THE AGED
Doing business as
THE LUTHERAN HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 11, 1989
Last certification
Mar 28, 2025
Beds
274
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
May 29, 1967 in MO
Enrollment address
2825 Bloomfield Road
Cape Girardeau, MO 63703-6335
Nursing home name
LUTHERAN HOME, THE

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lutheran Home, theCCN 265359
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 11, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
274176.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Home Hospice8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Jackie Payne Individual Corporate OfficerCfo Apr 26, 2018
W-2 Managing EmployeeCfo Apr 26, 2018
Cathy Goodman Individual Corporate DirectorBoard Member Jul 24, 2013
Harold Hale Individual Corporate DirectorBoard Member Dec 17, 2012
Rex Meyr Individual Corporate OfficerPresident Apr 1, 1997
Corporate DirectorBoard Member Apr 1, 1997
Teresa Brown Individual Corporate OfficerChief Operating Officer May 11, 2015
W-2 Managing EmployeeNursing Home Administrator May 11, 2015
Mark Kasten Individual Corporate DirectorBoard Member Apr 1, 2004
John Freeze Individual Corporate DirectorBoard Member Mar 18, 2012
Steve Schnieder Individual Corporate DirectorBoard Member Dec 22, 2014

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 9

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

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758844800000",
    "number": "1376539320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 BLOOMFIELD RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036398",
            "telephone_number": "573-335-0158",
            "fax_number": "573-986-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 BLOOMFIELD RD",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637036335",
            "telephone_number": "573-335-0158",
            "fax_number": "573-986-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOME FOR THE AGED",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2025-09-26",
        "certification_date": "2025-09-26",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-335-0158"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "030491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102445400",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "588585505",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288861503",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262445406",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "268861507",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292924008",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.