NPIMap

Organization Active NPI

Missouri Baptist Hospital of Sullivan

Doing business as Missouri Baptist Steelville Office

  • Rural Health Clinic/Center
  • Steelville, MO
National Provider Identifier
1487735445
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
355-24 Issued in MO
Legal business name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
Missouri Baptist Steelville Office
Practice address
510 West Main Street
Steelville, MO 65565
Phone
(573) 775-4600
NPI assigned
Oct 18, 2006
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Mr. Tony L Schwarm
Title
President
Phone
(573) 468-1343

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 355-24 MO Primary

Addresses

Primary practice location

510 West Main Street
Steelville, MO 65565

Mailing address

670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644

Other names 1

  • Missouri Baptist Steelville Office Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051205000439 MO Part A Provider - Rural Health Clinic 2668380148 Practice locations: Steelville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487735445. Details of each certification follow.

Rural health clinic certification: CCN 268528

Legal name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
MISSOURI BAPTIST STEELVILLE OFFICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 13, 2000
Last certification
Oct 2, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
510 W Main St
Steelville, MO 65565-8102
Related CCNs
261337

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

Locations

510 W Main St
Steelville, MO 65565
Phone (573) 468-4186

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Jennifer Fernando Barbin Individual Corporate OfficerChief of Staff Jan 1, 2025
Corporate DirectorChief of Staff Jan 1, 2025
Debbie Dixon Individual Corporate DirectorBoard Member Jan 1, 2004
Operational/Managerial ControlBoard Member Jan 1, 2004
Missouri Baptist Hospital of Sullivan Organization, Sullivan, MO Non-profit Operational/Managerial Control Jun 2, 1994
Tanya Voss Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Michael P Hoffman Individual Corporate OfficerBoard Member Jan 1, 2008
Corporate DirectorBoard Member Jan 1, 2008
Operational/Managerial ControlBoard Member Jan 1, 2008
Missouri Baptist Medical Center Organization, Town and Country, MO Non-profit Operational/Managerial Control Jun 2, 1994
BJC Health System Organization, Saint Louis, MO Non-profit Operational/Managerial Control Jun 2, 1994
Kelly King Individual Corporate DirectorBoard Member Jan 1, 2026
Trisha M Lollo Individual Corporate OfficerBoard Member Jan 1, 2026
Sharon Dace Individual Corporate DirectorBoard Member Jan 1, 2003
Operational/Managerial ControlBoard Member Jan 1, 2003
Brittni Garden Individual Corporate DirectorBoard Member Jan 1, 2025
Carmen Bartolotta Individual Corporate OfficerSecretary Jan 1, 2025
Jennifer Aven Individual Corporate DirectorBoard Member Jan 1, 2025
Irene Ruble Individual Corporate OfficerSecretary Nov 1, 1998
Corporate DirectorSecretary Nov 1, 1998
Operational/Managerial ControlSecretary Nov 1, 1998
Lisa Lochner Individual Corporate OfficerPresident Aug 19, 2021
W-2 Managing Employee Feb 1, 1994
Operational/Managerial Control Feb 1, 1994
Scott Hawig Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Joan Magruder Individual Corporate DirectorBoard Member Jan 1, 2023
Operational/Managerial ControlBoard Member Jan 1, 2023

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Missouri Baptist Cuba Medical OfficeCuba, MO, CCN 263407 Rural health clinic Operational/Managerial Control Jun 2, 1994
Sullivan Medical OfficeSullivan, MO, CCN 263487 Rural health clinic Operational/Managerial Control Jun 2, 1994

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1487735445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MASON RIDGE CENTER DR",
            "address_2": "SUITE 300",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418573",
            "telephone_number": "314-996-7644",
            "fax_number": "314-996-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 WEST MAIN STREET",
            "city": "STEELVILLE",
            "state": "MO",
            "postal_code": "65565",
            "telephone_number": "573-775-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI BAPTIST HOSPITAL OF SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "SCHWARM",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-468-1343",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "355-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "510 West Main Street",
            "city": "Steelville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "65565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Missouri Baptist Steelville Office",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Missouri Baptist Steelville Office",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Steelville, MO

Sources for this page

Verify at the official NPI Registry.