NPIMap

Organization Active NPI

Mercy Hospital Lebanon

  • General Acute Care Hospital
  • Lebanon, MO
National Provider Identifier
1447284898
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
450-6 Issued in MO
Legal business name
MERCY HOSPITAL LEBANON
Doing business as
Mercy Hospital Lebanon
Practice address
100 Hospital Dr
Lebanon, MO 65536
Phone
(417) 533-6100
Fax
(417) 533-6173
NPI assigned
Jul 10, 2006
Last updated
Feb 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Authorized official

Name
William J Roberts
Title
VP Finance
Phone
(417) 820-7363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 450-6 MO Primary

Addresses

Primary practice location

100 Hospital Dr
Lebanon, MO 65536

Mailing address

100 Hospital Dr
Lebanon, MO 65536-9210
Phone (417) 533-6100

Other identifiers 3

IdentifierTypeStateIssuer
010492007MedicaidMO
114678OtherMOHEALTHLINK COMMERCIAL
540492006MedicaidMO

Other names 1

  • Mercy Hospital Lebanon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040326000635 MO Part A Provider - Hospital 7214829019 1 other NPI on this enrollment
Practice locations: Rolla, MO; Saint Robert, MO; Lebanon, MO
O20040907000806 MO Part B Supplier - Clinic/Group Practice 7214829019 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
Practice locations: Lebanon, MO; Rolla, MO
O20041021000208 MO Part B Supplier - Clinic/Group Practice 7214829019 Receives reassigned benefits from 5 practitioners
Practice locations: Rolla, MO; Lebanon, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447284898. Details of each certification follow.

Hospital certification: CCN 260059

Legal name
MERCY HOSPITAL LEBANON
Doing business as
MERCY HOSPITAL LEBANON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 17, 2000
Beds
48
Ownership / control type
Church
Organization structure
CorporationNon-profit
Enrollment address
100 Hospital Dr
Lebanon, MO 65536-9210
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Hospital LebanonCCN 260059 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 110A
Rolla, MO 65401

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Rafael Bonilla Vasquez Individual Corporate DirectorBoard Member Jul 1, 2021
Byron Dudley Individual Corporate DirectorBoard Member Jul 1, 2021
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Jeremy Goforth Individual Corporate DirectorBoard Member Jul 1, 2021
David Schmitz Individual Corporate DirectorBoard Member Jul 1, 2021
Randall Angst Individual Corporate Director Jul 1, 2016
Mercy Health Springfield Communities Organization, Springfield, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 2, 2012 100%
Marsha J Vincent Individual Corporate DirectorBoard Member Jul 1, 2018
Stacie Farnam Individual W-2 Managing EmployeeDirector Jan 1, 2012
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Feb 1, 2012 100%
William J Roberts Individual Corporate OfficerTreasurer May 20, 2020
W-2 Managing EmployeeCfo May 20, 2020
Monty Hayes Individual Corporate DirectorBoard Member May 6, 2025
Steve Hite Individual Corporate DirectorBoard Member Jul 1, 2018
Amy Knight Individual Corporate DirectorBoard Member May 6, 2025
Greg Bechel Individual Corporate DirectorBoard Member Jul 1, 2022
Debbie Moore Individual Corporate DirectorBoard Member Jul 1, 2018
David G Argueta Individual Corporate OfficerPresident Jun 1, 2022
Brian Day Individual Corporate OfficerSenior Vice President May 6, 2025
John Carr Individual Corporate DirectorBoard Member Jul 1, 2021

Owners & managing parties with NPI records 1

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

Facilities with the same owner 115

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

View all 115

Practitioners & affiliated clinicians

Practitioners 53

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.

View all 53

Affiliated clinicians 412

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

View all 412

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1447284898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655369210",
            "telephone_number": "417-533-6100",
            "fax_number": "417-533-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "65536",
            "telephone_number": "417-533-6100",
            "fax_number": "417-533-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL LEBANON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "417-820-7363"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MO",
            "license": "450-6",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010492007",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK COMMERCIAL",
            "identifier": "114678",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540492006",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital Lebanon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Hospital Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.