Phelps County Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · St. James, MO
NPI 1457799520 · NPPES record last updated Feb 2, 2023
Key facts
- NPI
- 1457799520
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- PHELPS COUNTY REGIONAL MEDICAL CENTER
- Practice address
- 1000 N Jefferson Street
St. James, MO 65559-1078 - Phone
- (573) 265-8840
- Fax
- (573) 265-8884
- NPI assigned
- Jun 11, 2013
- Organization subpart
- No
Authorized official
- Name
- Jana Marie Cook
- Title
- Cfo/Sr. VP
- Phone
- (573) 458-7916
Owners & managing parties with NPI records 1
-
Mary V Graham, MD
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 6
Member of 1
Related certifications (CCN) 3
Facilities with the same owner 6
Practitioners 112
-
Nurelign G. Abebe, M.D.
-
Katie Ann Allen, RN,MSN,FNP-C
-
Patricia Louise Allen, APRN
-
Steven R Ballard, ANP
-
Mahmoud Ballout, MD
-
James Jeffrey Bass, M.D.
-
Christopher Black, CRNA
-
Sarah Elizabeth Bolin, CRNA, DNAP
-
Elliotte Schafer Bourne, PA-C
-
Miriam Louise Brawley, FNP-C
-
Kelcie Brunnert, CRNA, DNAP
-
Raymond E. Bruno, FNP
-
Melanie Cole Budnik, CRNA
-
Lisa M Burmeister, CRNA
-
Evan Ross Cameron, M.D.
-
Sellas Pecos Coble, D.O.
-
Jeffrey Colench, CRNA
-
Amber Cook, NP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0861908 | Phelps Health | Certificate of waiver | Dec 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Rural health clinic certification: CCN 268799
- Legal name
- PHELPS COUNTY REGIONAL MEDICAL CENTER
- Doing business as
- PHELPS HEALTH MEDICAL GROUP ST JAMES
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 1, 2023
- Last certification
- Feb 24, 2026
- Ownership / control type
- 2B
- Organization structure
- Other · Non-profit
- Enrollment address
- 1000 N Jefferson St
Saint James, MO 65559-1078 - Related CCNs
- 260017
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Phelps County Clerk |
Operational/Managerial Control | Nov 12, 2007 | |
| Ben Tipton |
Corporate Director |
Apr 26, 2024 | |
| Jason Shenefield |
Corporate Director |
Jul 22, 2021 | |
| W-2 Managing Employee |
Jul 22, 2021 | ||
| Richard Elgin |
Corporate Director |
Apr 1, 2023 | |
| Kimberley Bruno |
Corporate Director |
Aug 26, 2022 | |
| W-2 Managing Employee |
Aug 26, 2022 | ||
| Brittany Roth |
Corporate Director |
Aug 26, 2022 | |
| W-2 Managing Employee |
Aug 26, 2022 | ||
| Jana M Cook |
Corporate Director |
Jul 31, 2021 | |
| W-2 Managing Employee |
Jul 31, 2021 | ||
| Janece Martin |
Corporate Director |
May 6, 2022 | |
| Mary V. Graham |
Corporate Director |
Apr 23, 2026 | |
| Annie Bass |
Corporate Director |
May 6, 2022 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Phelps Health Home Health & Hospice |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Jun 11, 1998 |
| Phelps Health Home Health & Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jun 11, 1998 |
| Phelps Health Medical Group Vienna |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | May 1, 2007 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040106000405 | MO | Part B Supplier - Clinic/Group Practice | 2860391158 |
Receives reassigned benefits from 184 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cuba, MO; Waynesville, MO; Vienna, MO; Sullivan, MO; St. James, MO; Salem, MO; Saint James, MO; Rolla, MO… |
| O20230303001691 | MO | Part a Provider - Rural Health Clinic | 2860391158 | Practice locations: Saint James, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1000 N Jefferson Street
St. James, MO 65559-1078
Mailing address
PO Box 579
Rolla, MO 65402
Phone (573) 426-2182
Other names
- Phelps Health Medical Group St James
Other providers in St. James, MO
- Katherine O'Donnell
- Jennifer Nicole O'Malley
- Caitlyn Renee Ostrowski
- Kim Parker
- Brandy Ann Michelle Pfeifer
- Tricia L Phillips
- Preventive Healthcare
- Emma Reichel
- Scattered Oaks Inc.
- Petra Christina Scholz Gould
All providers in St. James, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.