NPIMap

Organization Active NPI

Three Rivers Hospice Inc

  • Community Based Hospice Care Agency
  • Platte City, MO
National Provider Identifier
1508882804
Registry record updated Aug 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
785-12HO Issued in MO
Legal business name
THREE RIVERS HOSPICE INC
Practice address
700 Branch Street
Suite #4 and #5
Platte City, MO 64079
Phone
(816) 431-2333
Fax
(816) 431-2334
NPI assigned
Jul 14, 2006
Last updated
Aug 27, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2018

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

Authorized official

Name
Donald B Bedell
Title
President
Phone
(573) 471-1276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 785-12HO MO Primary

Addresses

Primary practice location

700 Branch Street
Suite #4 and #5
Platte City, MO 64079

Mailing address

PO Box 1210
731 N Main Street
Sikeston, MO 63801-1210
Phone (573) 471-1276

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060420000086 MO Part A Provider - Hospice 1557370459 Practice locations: Cameron, MO; Lees Summit, MO; Platte City, MO; Saint Joseph, MO; Warrensburg, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508882804. Details of each certification follow.

Hospice certification: CCN 261621

Legal name
THREE RIVERS HOSPICE INC
Doing business as
THREE RIVERS HOSPICE NORTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 27, 2006
Last certification
May 14, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Sep 30, 2004 in MO
Enrollment address
700 Branch St
Ste 4
Platte City, MO 64079-9298

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Three Rivers HospiceCCN 261621 · All quality measures
Ownership
For-Profit
Certified
Sep 27, 2006
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1064527Three Rivers Hospice Inc700 Branch Street, Suite 4, Platte City, MO 64079Certificate of waiverFeb 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Hospice Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

631 N Spring Park Blvd
Mount Vernon, MO 65712
Phone (417) 461-0580

625 E Russell Ave
Warrensburg, MO 64093
Phone (660) 747-7512

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
Clifton L Shirrell Individual Corporate OfficerSecretary Dec 31, 2009
Dana N Wolf Individual W-2 Managing EmployeeAdministrator Apr 2, 2007
Circle B Enterprises Holding Company Inc Organization, Sikeston, MO Corporation, Holding company, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Todd Beaird Individual Corporate OfficerSecretary Jan 1, 2022
Donald B Bedell Individual Corporate OfficerPresident Nov 1, 2014
Corporate DirectorPresident Sep 30, 2004

Facilities with the same owner 33

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

View all 33

Practitioners & affiliated clinicians

Affiliated clinicians 21

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535328000000",
    "number": "1508882804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "address_2": "731 N MAIN STREET",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638011210",
            "telephone_number": "573-471-1276",
            "fax_number": "573-472-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 BRANCH STREET",
            "address_2": "SUITE #4 AND #5",
            "city": "PLATTE CITY",
            "state": "MO",
            "postal_code": "64079",
            "telephone_number": "816-431-2333",
            "fax_number": "816-431-2334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2018-08-27",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-471-1276"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "785-12HO",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Platte City, MO

Sources for this page

Verify at the official NPI Registry.