NPIMap

Organization Active NPI

General John J Pershing Memorial Hospital Association

Doing business as Communtiy Medical Associates

  • Rural Health Clinic/Center
  • Brookfield, MO
National Provider Identifier
1487616256
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Communtiy Medical Associates
Practice address
130 E Lockling St
Brookfield, MO 64628-2337
Phone
(660) 258-1050
Fax
(660) 258-1052
NPI assigned
Apr 5, 2006
Last updated
Nov 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Authorized official

Name
Mr. Kenneth E Baranski, CPA
Title
Cfo
Phone
(660) 258-1288

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

130 E Lockling St
Brookfield, MO 64628-2337

Mailing address

125 E Lockling St
P.O. Box 408
Brookfield, MO 64628-2367
Phone (660) 258-8237

Other names 1

  • Communtiy Medical Associates Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040624000322 MO Part A Provider - Rural Health Clinic 2860306750 Practice locations: Brookfield, MO
O20050422000230 MO Part B Supplier - Clinic/Group Practice 2860306750 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
Practice locations: Brookfield, MO; Meadville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487616256. Details of each certification follow.

Rural health clinic certification: CCN 268563

Legal name
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 12, 2003
Last certification
Oct 28, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1955 in MO
Enrollment address
130 E Lockling St
Brookfield, MO 64628-2337
Related CCNs
261307

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Pershing Hosp Home HLTH

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Kenneth E Baranski Individual Corporate DirectorCfo Jul 16, 2021
W-2 Managing EmployeeCfo Jul 16, 2021
James Elliot Individual Corporate DirectorBoard Member Jun 28, 2011
Brian L Winn Individual Corporate DirectorBoard Member May 6, 2014
Gary Routledge Individual Corporate DirectorBoard Member Jun 26, 2002
Joe Smith Individual Corporate DirectorBoard Member Jun 1, 2015
Gail Turner Individual Corporate DirectorBoard Member Jun 25, 2001
William Thudium Individual Corporate DirectorBoard Member Jun 24, 1991
David R Shaw Individual Corporate DirectorBoard Member Oct 23, 2011
Kelly C Schwager Individual W-2 Managing EmployeeClinic Director Nov 1, 2021
Karla D Clubine Individual Contracted Managing EmployeeCeo Nov 1, 2021
Corporate DirectorCeo Nov 1, 2021
Mark Cleveland Individual Corporate DirectorBoard Member Jun 24, 2005
Brian K Knowles Individual Corporate Director Jan 1, 2021
W-2 Managing Employee Jan 1, 2021

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Meadville Medical ClinicMeadville, MO, CCN 268682 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2012
Jul 10, 2012

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1487616256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 E LOCKLING ST",
            "address_2": "P.O. BOX 408",
            "city": "BROOKFIELD",
            "state": "MO",
            "postal_code": "646282367",
            "telephone_number": "660-258-8237",
            "fax_number": "660-258-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E LOCKLING ST",
            "city": "BROOKFIELD",
            "state": "MO",
            "postal_code": "646282337",
            "telephone_number": "660-258-1050",
            "fax_number": "660-258-1052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL ASSOCIATION",
        "enumeration_date": "2006-04-05",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "BARANSKI",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-258-1288",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Communtiy Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Communtiy Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, MO

Sources for this page

Verify at the official NPI Registry.