NPIMap

Organization Active NPI

Saint Francis Medical Center

  • Rural Health Clinic/Center
  • Charleston, MO
National Provider Identifier
1417424151
Registry record updated May 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAINT FRANCIS MEDICAL CENTER
Practice address
112 W Commercial St
Charleston, MO 63834-1601
Phone
(573) 683-4010
Fax
(573) 683-2167
NPI assigned
Oct 31, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2021

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

Authorized official

Name
Justin Davison
Title
Cfo
Phone
(573) 331-3000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

112 W Commercial St
Charleston, MO 63834-1601

Mailing address

PO Box 801143
Kansas City, MO 64180-1143
Phone (573) 331-5583

Other names 1

  • Saint Francis Clinic Charleston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040107000140 MO Part B Supplier - Clinic/Group Practice 9931007929 Receives reassigned benefits from 615 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20190220000146 MO Part A Provider - Rural Health Clinic 9931007929 Practice locations: Charleston, MO

Rural health clinic certification: CCN 263830

Legal name
SAINT FRANCIS MEDICAL CENTER
Doing business as
SAINT FRANCIS CLINIC CHARLESTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 21, 2010
Last certification
Oct 23, 2023
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2019 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 8, 1972 in MO
Enrollment address
112 W Commercial St
Charleston, MO 63834-1601

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 37

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

View all 37

National Provider Directory

National Provider Directory
Tax ID family
St Francis Medical Cent24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

112 W Commercial St
Charleston, MO 63834
Phone (573) 683-4010

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Laura L Younghouse Individual Corporate Director Jun 1, 2020
Gina Raffety Individual Corporate DirectorBoard Member Jul 1, 2019 100%
Adam Kidd Individual Corporate Director Jun 1, 2020
Mike Himmelberg Individual Corporate Director Aug 1, 2021
Justin Davison Individual Corporate OfficerCeo Jan 1, 2020
W-2 Managing EmployeeCeo Jan 1, 2020
Kathy Swan Individual Corporate Director Sep 1, 2021
Kimberly Wittenborn Individual W-2 Managing EmployeeMedical Staff Manager Jul 1, 2019 100%
Janet Varnon Individual Corporate DirectorBoard Member Jul 1, 2019 100%
Kevin Govero Individual Corporate DirectorChair of the Board Jul 1, 2019 100%
Kimberly Gilliland Individual W-2 Managing EmployeeAsst Coord, Payer Credentialing Oct 15, 2018
Dennis Vollink Individual Corporate DirectorSecretary/Treasurer Jul 1, 2019 100%
James H Bollinger Individual Corporate DirectorBoard Member Jul 1, 2019 100%
Timothy J Howell Individual W-2 Managing EmployeeReimbursement Specialist May 1, 2021
Blake Cosper Individual W-2 Managing EmployeeDirector of Reimbursement May 1, 2021
Joseph McLane Individual Corporate DirectorBoard Member Jul 1, 2019 100%
Saint Francis Medical Center Organization, Cape Girardeau, MO 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Steven Dirnberger Individual Corporate DirectorVice Chair Jul 1, 2019 100%

Owners & managing parties with NPI records 18

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

View all 18

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Francis Medical CenterCape Girardeau, MO, CCN 260183 Hospital Operational/Managerial Control Oct 2, 2007
St Francis Medical CenterCape Girardeau, MO, CCN 26T183 Hospital Operational/Managerial Control Oct 2, 2007
Saint Francis HospiceCape Girardeau, MO, CCN 261657 Hospice Operational/Managerial Control Jul 1, 2014
Saint Francis Clinic DexterDexter, MO, CCN 793839 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Saint Francis Clinic Cape Girardeau KingshighwayCape Girardeau, MO, CCN 263897 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2014
Saint Francis Clinic Poplar BluffPoplar Bluff, MO, CCN 263968 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2014
Saint Francis Clinic PiedmontPiedmont, MO, CCN 263933 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Saint Francis Clinic JacksonJackson, MO, CCN 263914 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 2, 2014
Saint Francis Clinic FarmingtonFarmington, MO, CCN 793859 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 16, 2021

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2019 Change of OwnershipThis provider was the buyer Ferguson Medical GroupCCN 263830, MO, NPI 1922332766

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1540944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621209600000",
    "number": "1417424151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801143",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801143",
            "telephone_number": "573-331-5583",
            "fax_number": "573-331-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W COMMERCIAL ST",
            "city": "CHARLESTON",
            "state": "MO",
            "postal_code": "638341601",
            "telephone_number": "573-683-4010",
            "fax_number": "573-683-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT FRANCIS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-31",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A",
        "authorized_official_last_name": "DAVISON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-3000"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Francis Clinic Charleston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, MO

Sources for this page

Verify at the official NPI Registry.