NPIMap

Organization Active NPI

Saint Francis Medical Center

Doing business as Saint Francis Clinic Poplar Bluff

  • Rural Health Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1689096919
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAINT FRANCIS MEDICAL CENTER
Doing business as
Saint Francis Clinic Poplar Bluff
Practice address
225 Physicians Park Ste 400
Poplar Bluff, MO 63901-3923
Phone
(573) 727-5500
Fax
(573) 727-5599
NPI assigned
Jan 6, 2014
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Justin Davison
Title
Cfo
Phone
(573) 331-3000

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Physician Assistant 363A00000X NU
Medical Physician Assistant 363AM0700X NU
Nurse Practitioner 363L00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
Family Nurse Practitioner 363LF0000X NU
Clinical Social Worker 1041C0700X NU
Registered Dietitian 133V00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Neurological Surgery Physician 207T00000X NU

Addresses

Primary practice location

225 Physicians Park Ste 400
Poplar Bluff, MO 63901-3923

Mailing address

PO Box 801143
Kansas City, MO 64180-1143
Phone (573) 331-5583

Other names 1

  • Saint Francis Clinic Poplar Bluff Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040107000140 MO Part B Supplier - Clinic/Group Practice 9931007929 Receives reassigned benefits from 615 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20160728002257 MO Part A Provider - Rural Health Clinic 9931007929 Practice locations: Poplar Bluff, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689096919. Details of each certification follow.

Rural health clinic certification: CCN 263968

Legal name
SAINT FRANCIS MEDICAL CENTER
Doing business as
SAINT FRANCIS CLINIC POPLAR BLUFF
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2003
Last certification
Jan 26, 2021
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2014 (1 total)
Organization structure
CorporationNon-profit
Incorporated
May 8, 1972 in MO
Enrollment address
225 Physicians Park
Ste 400
Poplar Bluff, MO 63901-3923

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 37

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

View all 37

National Provider Directory

National Provider Directory
Tax ID family
St Francis Medical Cent24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

Member of 1

Organizations this organization is a member of, according to the 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
Laura L Younghouse Individual Corporate DirectorBoard Member Jan 1, 2021
Gina Raffety Individual Corporate DirectorBoard Member Jul 1, 2019
Adam Kidd Individual Corporate DirectorBoard Member Jan 1, 2021
Mike Himmelberg Individual Corporate DirectorBoard Member Aug 1, 2021
Justin Davison Individual Corporate OfficerCfo, Ceo Jan 1, 2020
Corporate DirectorCfo, Ceo Feb 15, 2022
W-2 Managing EmployeeCfo, Ceo Jan 1, 2020
Kathy Swan Individual Corporate DirectorBoard Member Sep 1, 2021
Kimberly Wittenborn Individual W-2 Managing EmployeeDirector of Mso and PC Jul 1, 2019
Janet Varnon Individual Corporate DirectorBoard Member Jul 1, 2019
Kevin Govero Individual Corporate DirectorChair of the Board Jul 1, 2019
Kimberly Gilliland Individual W-2 Managing EmployeeCredentialing Coordinator Oct 15, 2018
Dennis Vollink Individual Corporate DirectorSecretary/Treasurer Jul 1, 2019
James H Bollinger Individual Corporate DirectorBoard Member Jul 1, 2019
Timothy J Howell Individual W-2 Managing EmployeeReimbursement Specialist Jun 1, 2021
Blake Cosper Individual W-2 Managing EmployeeDirector of Reimbursement Jun 1, 2021
Joseph McLane Individual Corporate DirectorBoard Member Jul 1, 2019
Saint Francis Medical Center Organization, Cape Girardeau, MO 5% Or Greater Direct Ownership Interest Jan 1, 2014
Steven Dirnberger Individual Corporate DirectorVice Chair Jul 1, 2019

Owners & managing parties with NPI records 18

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

View all 18

All facility ownership & control disclosures 9

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Saint Francis Medical CenterCape Girardeau, MO, CCN 260183 Hospital Operational/Managerial Control Oct 2, 2007
St Francis Medical CenterCape Girardeau, MO, CCN 26T183 Hospital Operational/Managerial Control Oct 2, 2007
Saint Francis HospiceCape Girardeau, MO, CCN 261657 Hospice Operational/Managerial Control Jul 1, 2014
Saint Francis Clinic DexterDexter, MO, CCN 793839 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Saint Francis Clinic Cape Girardeau KingshighwayCape Girardeau, MO, CCN 263897 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2014
Saint Francis Clinic PiedmontPiedmont, MO, CCN 263933 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Saint Francis Clinic JacksonJackson, MO, CCN 263914 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 2, 2014
Saint Francis Clinic CharlestonCharleston, MO, CCN 263830 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Saint Francis Clinic FarmingtonFarmington, MO, CCN 793859 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 16, 2021

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1388966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1689096919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801143",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641801143",
            "telephone_number": "573-331-5583",
            "fax_number": "573-331-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK STE 400",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013923",
            "telephone_number": "573-727-5500",
            "fax_number": "573-727-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT FRANCIS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-06",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "DAVISON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-3000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saint Francis Clinic Poplar Bluff",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.