NPIMap

Organization Active NPI

Mercy Hospital Jefferson

  • Rehabilitation Hospital Unit
  • Festus, MO
National Provider Identifier
1386823631
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
160-47 Issued in MO
Legal business name
MERCY HOSPITAL JEFFERSON
Practice address
1400 US Highway 61
Festus, MO 63028-4100
Phone
(636) 933-1000
Fax
(636) 933-1819
NPI assigned
Nov 2, 2007
Last updated
Apr 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Authorized official

Name
Mr. Dan Eckenfels
Title
President
Phone
(314) 525-1483

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 160-47 MO Primary

Addresses

Primary practice location

1400 US Highway 61
Festus, MO 63028-4100

Mailing address

1400 US Highway 61
Festus, MO 63028-4100
Phone (636) 933-1000

Other identifiers 1

IdentifierTypeStateIssuer
010155703MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071207000144 MO Part A Provider - Hospital 1254248271 Practice locations: Festus, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386823631. Details of each certification follow.

Hospital certification: CCN 26T023

Legal name
MERCY HOSPITAL JEFFERSON
Doing business as
MERCY HOSPITAL JEFFERSON
Organization structure
CorporationNon-profit
Enrollment address
1400 US Highway 61
Festus, MO 63028-4100
Hospital Rehabilitation Unit
Hospital subgroups
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
Mercy Hospital JeffersonCCN 26T023 · All quality measures
Ownership
Non-profit
Certified
Oct 1, 2007

National Provider Directory

National Provider Directory
Tax ID family
Hillsboro Medical Servi7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Daniel S Eckenfels Individual Corporate OfficerPresident Apr 23, 2025
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
William McKenna Individual Corporate DirectorBoard Member Jul 1, 2019
Elaine Gannon Individual Corporate DirectorBoard Member Jul 1, 2020
Richard Francis Individual Corporate DirectorBoard Member Jul 1, 2018
Tiffany Charleville Individual Corporate DirectorBoard Member Jul 1, 2022
Christine Blair Individual Corporate DirectorBoard Member Jul 1, 2022
Karthik V Iyer Individual Corporate DirectorBoard Member Jul 1, 2019
Denise Dix Individual Corporate DirectorBoard Member Jul 1, 2022
Dena McCaffrey Individual Corporate DirectorBoard Member Jul 1, 2019
Jacob W Peyton Individual Operational/Managerial Control Jul 1, 2020
Scott Martinez Individual Corporate OfficerTreasurer Apr 23, 2025
Tracy M Riordan Individual Corporate DirectorBoard Member Jul 1, 2019
Stacie Farnam Individual W-2 Managing EmployeeDirector Jul 8, 2022
Doug Ruess Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Feb 1, 2013 100%
Mercy Health East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2013 100%
Brian Day Individual Corporate OfficerSVP Apr 23, 2025

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 116

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

View all 116

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 4

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": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1386823631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-1000",
            "fax_number": "636-933-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 US HIGHWAY 61",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284100",
            "telephone_number": "636-933-1000",
            "fax_number": "636-933-1819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL JEFFERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "ECKENFELS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-525-1483",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MO",
            "license": "160-47",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010155703",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Festus, MO

Sources for this page

Verify at the official NPI Registry.