General John J Pershing Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Brookfield, MO
NPI 1487616256 · NPPES record last updated Nov 8, 2023
Key facts
- NPI
- 1487616256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 130 E Lockling St
Brookfield, MO 64628-2337 - Phone
- (660) 258-1050
- Fax
- (660) 258-1052
- NPI assigned
- Apr 5, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL ASSOCIATION
Authorized official
- Name
- Mr. Kenneth E Baranski, CPA
- Title
- Cfo
- Phone
- (660) 258-1288
Owners & managing parties with NPI records 3
-
Karla Denise Clubine, FNP/PNP
-
Brian Kevin Knowles, D.O.
-
Kelly Catherine Schwager, NP-C
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Member organizations 1
Related certifications (CCN) 1
Practitioners 29
-
Karla Denise Clubine, FNP/PNP
-
David A Fox II, M.D.
-
Robert Wayne Jackson, D.O.
-
Arihant Jain, M.D.
-
Brian Kevin Knowles, D.O.
-
Julie Ladd, FNP-C
-
Kelly Catherine Schwager, NP-C
-
Tara Lyrae Swan, APN
-
Karen A Sylvara, DO
-
William Tschannen, PA-C
-
Danny W Bartlett, MD
-
Paul Robert Jones, M.D.
-
Aaron Neisen, D.O.
-
Amber Denae Singer, NP-C
-
Jerry L Wait, DO
-
Garrett Nmi Elam, D.O.
-
Stephen Terrill, M.D.
-
Oge G Chukwu, M.D.
-
Jeanette Dilan-Koetje, D.O.
-
Erich Gerald Eriksen, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
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
- Corporation · Non-profit
- Incorporated
- Nov 1, 1955 in MO
- Enrollment address
- 130 E Lockling St
Brookfield, MO 64628-2337 - Related CCNs
- 261307
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Kenneth E Baranski |
Corporate Director |
Jul 16, 2021 | |
| W-2 Managing Employee |
Jul 16, 2021 | ||
| James Elliot |
Corporate Director |
Jun 28, 2011 | |
| Brian L Winn |
Corporate Director |
May 6, 2014 | |
| Gary Routledge |
Corporate Director |
Jun 26, 2002 | |
| Joe Smith |
Corporate Director |
Jun 1, 2015 | |
| Gail Turner |
Corporate Director |
Jun 25, 2001 | |
| William Thudium |
Corporate Director |
Jun 24, 1991 | |
| David R Shaw |
Corporate Director |
Oct 23, 2011 | |
| Kelly C Schwager |
W-2 Managing Employee |
Nov 1, 2021 | |
| Karla D Clubine |
Contracted Managing Employee |
Nov 1, 2021 | |
| Corporate Director |
Nov 1, 2021 | ||
| Mark Cleveland |
Corporate Director |
Jun 24, 2005 | |
| Brian K Knowles |
Corporate Director | Jan 1, 2021 | |
| W-2 Managing Employee | Jan 1, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Meadville Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 1, 2012 Jul 10, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- General John J Association
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 503898603 | Medicaid | MO | |
| 596059501 | Medicaid | MO |
Other names
- Communtiy Medical Associates
Other providers in Brookfield, MO
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- General John J Pershing Memorial Hospital Association
- Kendal Lewis Geno
- Vivian Marlene Hall
- Hannibal Regional Healthcare System, Inc.
All providers in Brookfield, 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 Nov 8, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.