NPIMap

Organization Active NPI

Missouri Baptist Hospital of Sullivan

Doing business as Missouri Baptist Sullivan Hospital

  • Psychiatric Hospital Unit
  • Sullivan, MO
National Provider Identifier
1497763361
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
355-24 Issued in MO
Legal business name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
Missouri Baptist Sullivan Hospital
Practice address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone
(573) 468-4186
Fax
(573) 860-2696
NPI assigned
Aug 4, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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
Psychiatric Hospital Unit 273R00000X 355-24 MO Primary

Addresses

Primary practice location

751 Sappington Bridge Rd
Sullivan, MO 63080-2354

Mailing address

751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Phone (573) 468-1343

Other identifiers 7

IdentifierTypeStateIssuer
108OtherBLUE CROSS-BLUE SHIELD
800565004MedicaidMO
489665OtherAETNA
MI010565000MedicaidMO
108OtherBLUE CHOICE
260115OtherPREMIER PLUS
540565009MedicaidMO

Other names 1

  • Missouri Baptist Sullivan Hospital 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
O20121011000008 MO Part A Provider - Critical Access Hospital 2668380148 Practice locations: Sullivan, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497763361. Details of each certification follow.

Hospital certification: CCN 26M337

Legal name
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
Doing business as
MISSOURI BAPTIST SULLIVAN HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
751 Sappington Bridge Rd
Sullivan, MO 63080-2354
Other Hospital Practice 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 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
Michele McKee Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Thomas J Jackson Individual Corporate DirectorChief Medical Officer Jan 1, 2021
Operational/Managerial ControlChief Medical Officer Jan 1, 2021
Tanya Voss Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Missouri Baptist Medical Center Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Oct 15, 2002
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 DirectorSecretary 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 Sep 1, 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
BJC Health System Organization, Saint Louis, MO Non-profit Operational/Managerial Control Sep 1, 2012

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 3

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
Missouri Baptist Steelville OfficeSteelville, MO, CCN 268528 Rural health clinic Operational/Managerial Control Jun 2, 1994

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 12

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

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1497763361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "573-468-1343",
            "fax_number": "573-860-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 SAPPINGTON BRIDGE RD",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802354",
            "telephone_number": "573-468-4186",
            "fax_number": "573-860-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI BAPTIST HOSPITAL OF SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-07-21",
        "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": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MO",
            "license": "355-24",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS-BLUE SHIELD",
            "identifier": "108",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800565004",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "489665",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MI010565000",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "108",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMIER PLUS",
            "identifier": "260115",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540565009",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "751 Sappington Bridge Rd",
            "city": "Sullivan",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630802354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Missouri Baptist Sullivan Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Missouri Baptist Sullivan Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.