NPIMap

Organization Active NPI

Mercy Hospital Tishomingo, Inc.

Doing business as Mercy Hospital Tishomingo Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Tishomingo, OK
National Provider Identifier
1578868121
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
MERCY HOSPITAL TISHOMINGO, INC.
Doing business as
Mercy Hospital Tishomingo Swing Bed
Practice address
1000 S Byrd St
Tishomingo, OK 73460-3265
Phone
(580) 371-2327
NPI assigned
Jan 12, 2011
Last updated
Oct 12, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY TISHOMINGO HOSPITAL CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Authorized official

Name
Tracy Enloe
Title
Cfo
Phone
(405) 752-3161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary

Addresses

Primary practice location

1000 S Byrd St
Tishomingo, OK 73460-3265

Mailing address

1000 S Byrd St
Tishomingo, OK 73460-3265

Other names 1

  • Mercy Hospital Tishomingo Swing Bed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220807000107 OK Part A Provider - Critical Access Hospital 1557542032 Practice locations: Tishomingo, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578868121. Details of each certification follow.

Hospital certification: CCN 37Z304

Legal name
MERCY HOSPITAL TISHOMINGO INC
Organization structure
CorporationNon-profit
Enrollment address
1000 S Byrd St
Tishomingo, OK 73460-3265
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Part of
Mercy Hospital Tishomingo Inc

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John M Mohart Individual Corporate Director Jul 1, 2021
Cheryl L Matejka Individual Operational/Managerial ControlSVP-Cfo Jul 1, 2021
Yogya Regmi Individual W-2 Managing Employee Aug 29, 2022
Marvin Bostrom Individual Corporate DirectorBoard Member Jul 1, 2022
Shelley Gilbert Individual Corporate DirectorBoard Member Jul 1, 2021
Jeffrey Peter Ciaramita Individual Corporate Director Jul 1, 2021
Christie Eckhardt Individual Corporate OfficerSecretary Jul 1, 2021
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit Operational/Managerial Control Aug 20, 2011 100%
Mercy Health Oklahoma Communities Organization, Oklahoma City, OK Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 11, 2012 100%
Mercy Hospital Ada Inc Organization, Ada, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP of Finance-Cah Jan 1, 2021

Owners & managing parties with NPI records 7

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

Facilities with the same owner 118

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

View all 118

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 61

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539302400000",
    "number": "1578868121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265",
            "telephone_number": "580-371-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL TISHOMINGO, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY TISHOMINGO HOSPITAL CORPORATION",
        "enumeration_date": "2011-01-12",
        "last_updated": "2018-10-12",
        "status": "A",
        "authorized_official_last_name": "ENLOE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "405-752-3161"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital Tishomingo Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Hospital Tishomingo Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tishomingo, OK

Sources for this page

Verify at the official NPI Registry.