NPIMap

Organization Active NPI

Russellville Holdings LLC

Doing business as Saint Mary's Regional Medical Center Rehab

  • Rehabilitation Hospital Unit
  • Russellville, AR
National Provider Identifier
1376595132
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
4192 Issued in AR
Legal business name
RUSSELLVILLE HOLDINGS LLC
Doing business as
Saint Mary's Regional Medical Center Rehab
Practice address
1808 W Main St
Russellville, AR 72801-2724
Phone
(479) 968-2841
Fax
(479) 968-8189
NPI assigned
May 17, 2006
Organization subpart
Yes
Parent organization
RUSSELLVILLE HOLDINGS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Authorized official

Name
Charlotte Lawrence
Title
Secretary
Phone
(615) 920-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 4192 AR Primary

Addresses

Primary practice location

1808 W Main St
Russellville, AR 72801-2724

Mailing address

330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000

Other names 1

  • Saint Mary's Regional Medical Center Rehab Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address saintmarysregmedcen@smrmc.medalliesdirect.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070912000362 AR Part A Provider - Hospital 1052217452 Practice locations: Russellville, AR

Hospital certification: CCN 04T041

Legal name
RUSSELLVILLE HOLDINGS LLC
Doing business as
ST MARY'S REGIONAL MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Feb 3, 1999 in DE
Enrollment address
1808 W Main St
Russellville, AR 72801-2724
Hospital Rehabilitation Unit
Hospital subgroups
Acute care, Rehabilitation, Rehabilitation unit

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

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: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
S. Marys Regional Medical CenterCCN 04T041 · All quality measures
Ownership
For profit
Certified
Aug 26, 1992

National Provider Directory

National Provider Directory
Tax ID family
Russellville Holdings LLC2 organizations share this tax ID, including this one
Part of
Russellville Holdings LLC

Other organizations with this tax ID 1

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
DSB Acquisition LLC Organization, New York, NY For-profit 5% Or Greater Indirect Ownership Interest May 2, 2016 100%
Casey Willis Individual Contracted Managing EmployeeFacility Ceo Apr 15, 2024
St Marys Holding LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 30, 2008 100%
Lifepoint Health Inc Organization, Brentwood, TN For-profit 5% Or Greater Indirect Ownership Interest Nov 16, 2018 100%
Marcus B Poppell Individual Corporate OfficerSenior Vice President Nov 16, 2018
William Ziesmer Individual Corporate OfficerCfo Feb 12, 2024
Charlotte E Lawrence Individual Corporate OfficerSecretary Jan 21, 2022
Capella Holdings LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2016 100%
Capella Healthcare LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2016 100%
John Michael Grooms Individual Corporate OfficerSenior Vice President and Treasurer Nov 16, 2018
Christopher J Monte Individual Corporate OfficerVice President Nov 16, 2018
Jennifer Alderfer Individual Corporate OfficerPresident Oct 30, 2023
Lima Holdco LLC Organization, Brentwood, TN LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 100%
Capella Health Holdings LLC Organization, Brentwood, TN LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 31, 2015 100%

Facilities with the same owner 34

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

View all 34

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 3

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690761600000",
    "number": "1376595132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 SEVEN SPRINGS WAY",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275098",
            "telephone_number": "615-920-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012724",
            "telephone_number": "479-968-2841",
            "fax_number": "479-968-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUSSELLVILLE HOLDINGS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RUSSELLVILLE HOLDINGS LLC",
        "enumeration_date": "2006-05-17",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "615-920-7000"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "AR",
            "license": "4192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "saintmarysregmedcen@smrmc.medalliesdirect.net",
            "affiliation": "N",
            "address_1": "1808 W Main St",
            "city": "Russellville",
            "state": "AR",
            "country_code": "US",
            "postal_code": "728012724",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Saint Mary's Regional Medical Center Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Saint Mary's Regional Medical Center Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.