NPIMap

Organization Active NPI

Mosaic Medical Center - Maryville

  • Psychiatric Hospital Unit
  • Maryville, MO
National Provider Identifier
1477027803
Registry record updated Mar 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
MOSAIC MEDICAL CENTER - MARYVILLE
Practice address
2016 S Main St
Maryville, MO 64468-2655
Phone
(660) 562-2600
Fax
(660) 562-7943
NPI assigned
Jan 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2019

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

Authorized official

Name
Dwight R Carvell
Title
Director of Reimbursement
Phone
(816) 273-0473

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

2016 S Main St
Maryville, MO 64468-2655

Mailing address

2016 S Main St
Maryville, MO 64468-2655
Phone (660) 562-2600

Other names 1

  • Mosaic Behavioral Health - Maryville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250220004050 MO Part A Provider - Critical Access Hospital 3678813896 Practice locations: Maryville, MO

Hospital certification: CCN 26M340

Legal name
MOSAIC MEDICAL CENTER - MARYVILLE
Organization structure
CorporationNon-profit
Enrollment address
2016 S Main St
Maryville, MO 64468-2655
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Renee Hayes Individual W-2 Managing Employee Jan 1, 2024
Michael M Poore Individual Corporate Officer Jan 1, 2024
Dwight Carvell Individual Corporate Officer Jan 1, 2024
Mosaic Health System Organization, Saint Joseph, MO Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2024
Serena Naylor Individual Corporate Director Jan 1, 2024

Facilities with the same owner 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 200

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

View all 200

NPI Registry JSON

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

{
    "created_epoch": "1547769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1477027803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682655",
            "telephone_number": "660-562-2600",
            "fax_number": "660-562-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "MARYVILLE",
            "state": "MO",
            "postal_code": "644682655",
            "telephone_number": "660-562-2600",
            "fax_number": "660-562-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSAIC MEDICAL CENTER - MARYVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-18",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "CARVELL",
        "authorized_official_first_name": "DWIGHT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "816-273-0473"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mosaic Behavioral Health - Maryville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maryville, MO

Sources for this page

Verify at the official NPI Registry.