NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center LLC

Doing business as Poplar Bluff Regional Medical Center

  • General Acute Care Hospital
  • Poplar Bluff, MO
National Provider Identifier
1700831724
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
4852 Issued in MO
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
Poplar Bluff Regional Medical Center
Practice address
3100 Oak Grove Rd.
Poplar Bluff, MO 63901
Phone
(573) 686-5311
NPI assigned
May 24, 2006
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Paula Lalor
Title
Director/Delegated Official
Phone
(629) 215-3953

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 4852 MO
General Acute Care Hospital 282N00000X 4852 MO Primary
Certified Registered Nurse Anesthetist 367500000X

Addresses

Primary practice location

3100 Oak Grove Rd.
Poplar Bluff, MO 63901

Mailing address

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 712-2546

Other identifiers 3

IdentifierTypeStateIssuer
011602505MedicaidMO
541602504MedicaidMO
61OtherMOBLUE CROSS

Other names 1

  • Poplar Bluff Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030909000031 MO Part A Provider - Hospital 6800707225 Practice locations: Doniphan, MO; Malden, MO; Piedmont, MO; Poplar Bluff, MO
O20071116000008 MO Part B Supplier - Clinic/Group Practice 6800707225 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Advance, MO; Bernie, MO; Bloomfield, MO; Dexter, MO; Puxico, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700831724. Details of each certification follow.

Hospital certification: CCN 260119

Legal name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
POPLAR BLUFF REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 20, 2010
Beds
230
Ownership / control type
Private (for profit)
Most recent change of ownership
Nov 1, 2003 (3 total)
Organization structure
LLCProprietary
Incorporated
Apr 14, 2009 in MO
Enrollment address
3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Poplar Bluff Regional Medical CenterCCN 260119 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

4 Oak Tree Vlg
Doniphan, MO 63935
Phone (573) 996-5910

806 N Douglass St
Malden, MO 63863
Phone (573) 276-3863

2002 Kanell Blvd
Ste 106
Poplar Bluff, MO 63901
Phone (573) 331-3710

2210 Barron Rd
Ste 205
Poplar Bluff, MO 63901
Phone (573) 686-5374

2210 Barron Rd
Ste 210
Poplar Bluff, MO 63901
Phone (573) 686-5330

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kevin J Hammons Individual Corporate OfficerPresident/Board Member Feb 1, 2019
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Jul 15, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
Health Management Associates LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 99%
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Central States Hma Holdings LLC Organization, Franklin, TN 5% Or Greater Direct Ownership Interest Jan 27, 2014 100%
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Health Management Associates LP Organization, Franklin, TN 5% Or Greater Indirect Ownership Interest Jan 27, 2014 99%
Eric Naegler Individual W-2 Managing EmployeeCeo Jul 15, 2019
Paula M Lalor Individual Corporate DirectorDirector PFS Apr 1, 2017
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary Jan 27, 2014
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 100%

Facilities with the same owner 120

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

  • Kirksville Missouri Hospital Company LLC

    dba Northeast Regional Medical Group

    • Rural Health Clinic/Center
    • Kirksville, MO
    • NPI 1508135005

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • General Acute Care Hospital
    • Kirksville, MO
    • NPI 1104899442

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Kirksville, MO
    • NPI 1932172293

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Moberly, MO
    • NPI 1346212784

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Psychiatric Hospital Unit
    • Moberly, MO
    • NPI 1366413882

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Rural Health Clinic

    • Rural Health Clinic/Center
    • Moberly, MO
    • NPI 1407989510

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • General Acute Care Hospital
    • Moberly, MO
    • NPI 1770554305

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Chariton Valley Family Medicine

    • Rural Health Clinic/Center
    • Salisbury, MO
    • NPI 1851713580

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Puxico Medical Clinic

    • Rural Health Clinic/Center
    • Puxico, MO
    • NPI 1275576654

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Dexter Medical Center

    • Rural Health Clinic/Center
    • Dexter, MO
    • NPI 1700821212

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Malden Medical Center

    • Rural Health Clinic/Center
    • Malden, MO
    • NPI 1801839147

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Poplar Bluff Regional Medical Center

    • Rehabilitation Hospital Unit
    • Poplar Bluff, MO
    • NPI 1962446054

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
View all 120

Practitioners & affiliated clinicians

Practitioners 143

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 143

Affiliated clinicians 366

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

View all 366

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1700831724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-712-2546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD.",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-686-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "MO",
            "license": "4852",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MO",
            "license": "4852",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011602505",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "541602504",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "61",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Bluff Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.