NPIMap

Organization Active NPI

Mercy Hospital Lincoln

Doing business as Mercy Hospital Lincoln Family Medicine Elsberry

  • Rural Health Clinic/Center
  • Elsberry, MO
National Provider Identifier
1578969366
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL LINCOLN
Doing business as
Mercy Hospital Lincoln Family Medicine Elsberry
Practice address
106 Broadway St
,Suite 3C
Elsberry, MO 63343-1345
Phone
(573) 898-9100
NPI assigned
Nov 6, 2014
Last updated
Sep 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Authorized official

Name
Mark Thorn
Title
Executive Director Finance
Phone
(636) 528-3329

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

106 Broadway St
,Suite 3C
Elsberry, MO 63343-1345

Mailing address

106 Broadway St
,Suite 3C
Elsberry, MO 63343-1345
Phone (573) 898-9100

Other names 1

  • Mercy Hospital Lincoln Family Medicine Elsberry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150219000013 MO Part A Provider - Rural Health Clinic 5193040020 Practice locations: Elsberry, MO
O20150623002541 MO Part B Supplier - Clinic/Group Practice 5193040020 Receives reassigned benefits from 232 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elsberry, MO; Troy, MO; Winfield, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578969366. Details of each certification follow.

Rural health clinic certification: CCN 268663

Legal name
MERCY HOSPITAL LINCOLN
Doing business as
MERCY HOSPITAL LINCOLN FAMILY MEDICINE ELSBERRY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 24, 2011
Last certification
Oct 21, 2024
Ownership / control type
2B
Most recent change of ownership
Mar 1, 2015 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 31, 2014 in MO
Enrollment address
106 Broadway St
Ste 3C
Elsberry, MO 63343-1345
Related CCNs
261319

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Lincoln10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Member of 1

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

Locations

106 Broadway St
Ste 3C
Elsberry, MO 63343
Phone (573) 898-9100

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Suzette Morris Individual Corporate DirectorBoard Member Apr 27, 2025
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Mercy Hospitals East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 2, 2015 100%
Claudia Ward Individual Corporate Director Jul 1, 2021
Annette S Meyer Individual Corporate DirectorBoard Member Jul 1, 2022
Sarah Burkemper Individual Corporate DirectorBoard Member Jul 1, 2021
Mark a Thorn Individual Corporate OfficerTreasurer Jul 1, 2021
W-2 Managing EmployeeExecutive Director of Finance Mar 1, 2015
John Barry Kelly Individual Corporate Director Jul 1, 2021
Anthony Rothermich Individual Corporate OfficerPresident Mar 1, 2015
Timothy L Reller Individual Corporate DirectorBoard Member Jul 1, 2020
Bradley J Massey Individual Corporate DirectorBoard Member Jul 1, 2020
Stacie Farnam Individual W-2 Managing EmployeeDirector Jul 8, 2022
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office Operational/Managerial Control Mar 1, 2015 100%
David J Meiners Individual Corporate Director Jul 1, 2022
Harvey D Rhoads Individual Corporate DirectorBoard Member Nov 19, 2019
Mark Penny Individual Corporate DirectorChairman Jul 1, 2020
Mercy Health East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 2, 2015 100%
Rod Hamlett Individual Corporate DirectorBoard Member Apr 27, 2025
Brian Day Individual Corporate OfficerSVP Apr 27, 2025

Owners & managing parties with NPI records 6

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

Facilities with the same owner 117

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

View all 117

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632700800000",
    "number": "1578969366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BROADWAY ST",
            "address_2": ",SUITE 3C",
            "city": "ELSBERRY",
            "state": "MO",
            "postal_code": "633431345",
            "telephone_number": "573-898-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BROADWAY ST",
            "address_2": ",SUITE 3C",
            "city": "ELSBERRY",
            "state": "MO",
            "postal_code": "633431345",
            "telephone_number": "573-898-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL LINCOLN",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "THORN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR FINANCE",
        "authorized_official_telephone_number": "636-528-3329"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Hospital Lincoln Family Medicine Elsberry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elsberry, MO

Sources for this page

Verify at the official NPI Registry.