Carroll County Memorial Hospital
Organization Active NPI Critical Access Hospital · Carrollton, MO
NPI 1528067113 · NPPES record last updated Oct 29, 2021
Key facts
- NPI
- 1528067113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 210-45 (MO)
- Legal business name
- CARROLL COUNTY MEMORIAL HOSPITAL
- Practice address
- 1502 N Jefferson St
Carrollton, MO 64633-1948 - Phone
- (660) 542-1695
- Fax
- (660) 542-0363
- NPI assigned
- Jul 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Amy Danielle Ireland
- Title
- Cfo
- Phone
- (660) 329-6005
Owners & managing parties with NPI records 2
-
Jennifer Rose Poston, O.D.
Owned or controlled facilities with NPI records 3
Member organizations 6
Related certifications (CCN) 3
Facilities with the same owner 3
Practitioners 99
-
Sri Krishna Alapati, M.D.
-
Jonathan Curran, CRNA
-
John Paul Eggers, MD, PHD
-
John C Ellis, M.D.
-
Eben Eno Mbei, M.D.
-
Ryan P Frank, D.P.M.
-
Andrew Douglas Horine, D.O.
-
Emily Claire Larson, D.O.
-
Heidi L Leimkuehler, APRN, FNP-C
-
Bradley J Moore, M.D.
-
Pamela Lynn Ralls, M.D.
-
Jonna Hickcox Rechterman, APRN FNP
-
Dennis L Smith, D.O.
-
Richard Lee Smith, M.D.
-
Housam Soukieh, MD
-
Jonathan Edward Wilson, D.O.
-
Matthew Bassett, M.D.
Affiliated clinicians 90
-
Brandon Kent Albrecht, CRNA
-
Gabriel Anders, D.O.
-
Blake Jay Brooks, M.D.
-
Scott S Chapman, MD
-
Paul Ren Chu, M.D.
-
Jonathan Curran, CRNA
-
Justin Dastrup, DO
-
William E Decker, MD
-
Jeffrey L Dryden, D.O.
-
James T Edinger, MD
-
John Paul Eggers, MD, PHD
-
John C Ellis, M.D.
-
Mahmoud Elsayed, M.D.
-
Eben Eno Mbei, M.D.
-
Ryan P Frank, D.P.M.
-
Lancer Gentry Gates, D.O.
-
Tapas Ghose, M.D.
-
Nicholas Gier, M.D.
Medicare Care Compare: Hospital
- Listed as
- Carroll County Memorial Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO
Hospital certification: CCN 261332
- Legal name
- CARROLL COUNTY MEMORIAL HOSPITAL
- Doing business as
- CARROLL COUNTY MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Nov 1, 2005
- Last certification
- Sep 13, 2023
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1502 N Jefferson St
Carrollton, MO 64633-1948
Hospital certification: CCN 26Z332
- Legal name
- CARROLL COUNTY MEMORIAL HOSPITAL
- Doing business as
- CARROLL COUNTY MEMORIAL HOSPITAL
- Organization structure
- Other · Non-profit
- Enrollment address
- 1502 N Jefferson St
Carrollton, MO 64633-1948
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Timothy N Reid |
Corporate Officer |
Jan 1, 2021 | |
| Janice Burnside |
Corporate Officer |
Oct 1, 2025 | |
| Jennifer Link |
Corporate Officer |
Oct 1, 2025 | |
| Charles Riley |
Corporate Director |
Oct 1, 2025 | |
| W-2 Managing Employee |
Oct 1, 2025 | ||
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Anna Barlow |
Corporate Officer |
Jan 1, 2021 | |
| Jennifer R Poston |
Corporate Officer |
Jan 1, 2021 | |
| Michael Schubach |
Corporate Director |
Oct 1, 2025 | |
| W-2 Managing Employee |
Oct 1, 2025 | ||
| Operational/Managerial Control |
Oct 1, 2025 | ||
| Kenneth Brown |
Corporate Officer | Oct 1, 2025 | |
| Corporate Officer |
Oct 1, 2025 | ||
| Matthew Lock |
Corporate Officer |
Jan 1, 2021 | |
| Tracey Woodward |
Corporate Officer |
Oct 1, 2025 | |
| George Thomas Burkhart |
Corporate Officer |
Oct 1, 2025 | |
| Wade Mertensmeyer |
Corporate Officer |
Jan 1, 2021 | |
| Carroll County Memorial Hospital |
5% Or Greater Direct Ownership Interest | May 10, 2011 | 100% |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Jefferson Medical Group |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
| Jefferson Medical Group Hale Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1966 |
| Jefferson Medical Group |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040407000120 | MO | Part B Supplier - Clinic/Group Practice | 2860485638 |
Receives reassigned benefits from 84 practitioners Practice locations: Carrollton, MO |
| O20061104000585 | MO | Part a Provider - Critical Access Hospital | 2860485638 |
Receives reassigned benefits from 8 practitioners Practice locations: Carrollton, MO |
| O20120419000092 | MO | Part a Provider - Critical Access Hospital | 2860485638 | Practice locations: Carrollton, MO |
National Provider Directory
Locations
1413 N Jefferson St
Carrollton, MO 64633
Phone (660) 259-2440
1407 N Jefferson St
Carrollton, MO 64633
Phone (660) 542-1952
Interoperability endpoints
- tanyaland@ccmhospital.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 26Z332 | MO | |
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | MO | ||
| Critical Access Hospital | 282NC0060X | 210-45 | MO | Yes |
Addresses
Primary practice location
1502 N Jefferson St
Carrollton, MO 64633-1948
Mailing address
1502 N Jefferson
Carrollton, MO 64633-1948
Phone (660) 542-1695
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90017016 | Other | MO | BCBS |
| 010157907 | Medicaid | MO |
Other names
- Carroll County Memorial Hospital
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | CCMHHIMDept@ccmhospital.cernerdirect.com | Direct |
Other providers in Carrollton, MO
- Carroll County Ambulance District
- Carroll County Health Department
- Carroll County Hospital Phtysicians
- Carroll County Medical Clinic
- Carroll County Memorial Hospital
- Carroll County Memorial Hospital
- Carroll House, Inc.
- Carrollton Chiropractic Clinic, LLC
- Carrollton Dental Clinic
- Carrollton R-VII
All providers in Carrollton, MO · Critical Access Hospital in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.