Poplar Bluff Regional Medical Center LLC
Organization Active NPI General Acute Care Hospital · Poplar Bluff, MO
NPI 1700831724 · NPPES record last updated Apr 20, 2021
Key facts
- NPI
- 1700831724
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 4852 (MO)
- Legal business name
- POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
- Practice address
- 3100 Oak Grove Rd.
Poplar Bluff, MO 63901 - Phone
- (573) 686-5311
- NPI assigned
- May 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Paula Lalor
- Title
- Director/Delegated Official
- Phone
- (629) 215-3953
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 7
Member organizations 3
Related certifications (CCN) 6
Facilities with the same owner 120
Practitioners 146
-
Aaron Aden, FNP
-
Amy McKell Cluck, NURSE PRACTITIONER
-
Jamie Lynn Morse, NP-C
-
Holly Nicole Reed, FNP-BC
-
John L Hunt, M.D.
-
Sherry Limbaugh, FNP
-
Angela L Patterson, M.D.
-
Jane Anni, MD
-
Amanda Elaine Bader, FNP-BC
-
Tonya McClain, PNP
-
Edward D Reese, M.D.
-
Jennetta Sue Stearns, FNP
-
Kimberly Dawn Te, FNP-BC
-
Donna D Akers, FNP-C
-
John Bollenbacher, CRNA
-
Ricky R Brown, CRNA
-
Fred M. Caldwell, M.D.
-
Rita Cannon, NURSE PRACTIONER
-
Poppy Daniels, MD
-
Gary W Dausmann, MD
Affiliated clinicians 366
-
Karen M Abt, FNP
-
Holly Maria Adams, MSN, FNP-BC
-
Aaron Aden, FNP
-
Syed Ijlal Ahmed, MD
-
Veysel Akgun, MD
-
Debra M Alexander, MSN, APRN, BC-FNP
-
Mohanad Ali Alfaqih, M.D
-
Ensaf Alhujaily, MD
-
Michelle Allen, FNP
-
Mohammed Alomgir, DO
-
Khadrah M Alsomali, M.D
-
Chad Armstrong, DO
-
Hussein Rami Asad, M.D.
-
Tony J Asante, MD
-
Meighan Austin, RN
-
Ustun Aydingoz, MD
-
Amanda Elaine Bader, FNP-BC
-
Matthew Christopher Bean, M.D.
-
Leona M Bergen, ACNPC-AG
-
Chelsea Bilderback, FNP-C
Medicare Care Compare: Hospital
- Listed as
- Poplar Bluff Regional Medical Center
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Proprietary
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
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
- LLC · Proprietary
- Incorporated
- Apr 14, 2009 in MO
- Enrollment address
- 3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin J Hammons |
Corporate Officer |
Feb 1, 2019 | |
| Corporate Director |
Jan 1, 2020 | ||
| Nathaniel K Summar |
Corporate Director |
Jul 15, 2017 | |
| Justin D Pitt |
Corporate Officer |
Mar 1, 2022 | |
| Corporate Director |
Mar 1, 2022 | ||
| Health Management Associates LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 99% |
| William Bradley Cash |
Corporate Officer |
Jun 1, 2018 | |
| Hma-Tri Holdings LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 100% |
| Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Jan 27, 2014 | 100% |
| Jason Kevin Johnson |
Corporate Officer |
Jan 6, 2020 | |
| Central States Hma Holdings LLC |
5% Or Greater Direct Ownership Interest | Jan 27, 2014 | 100% |
| Roman Gabriel Ottinger |
Corporate Officer |
Jan 6, 2020 | |
| Health Management Associates LP |
5% Or Greater Indirect Ownership Interest | Jan 27, 2014 | 99% |
| Eric Naegler |
W-2 Managing Employee |
Jul 15, 2019 | |
| Paula M Lalor |
Corporate Director |
Apr 1, 2017 | |
| Edna S Buffington-Price |
Corporate Director |
Mar 1, 2022 | |
| Christopher G Cobb |
Corporate Officer |
Jan 27, 2014 | |
| CHS Community Health Systems Inc |
5% Or Greater Indirect Ownership Interest | Jan 27, 2014 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
4 Oak Tree Vlg
Doniphan, MO 63935
Phone (573) 996-5910
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
130 E Harbin Ave
Puxico, MO 63960
Phone (573) 222-3556
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | 4852 | MO | |
| General Acute Care Hospital | 282N00000X | 4852 | MO | Yes |
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 541602504 | Medicaid | MO | |
| 61 | Other | MO | BLUE CROSS |
| 011602505 | Medicaid | MO |
Other names
- Poplar Bluff Regional Medical Center
Other providers in Poplar Bluff, MO
- Poplar Bluff Radiology Services Inc
- Poplar Bluff Regional Medical Center
- Poplar Bluff Regional Medical Center Inc
- Poplar Bluff Regional Medical Center Inc
- Poplar Bluff Regional Medical Center LLC
- Poplar Bluff Regional Medical Center LLC
- Poplar Bluff Regional Medical Center LLC
- Poplar Bluff Regional Medical Center, Inc
- Poplar Bluff Regional Medical Center, LLC
- Poplar Bluff Regional Medical Center, LLC
All providers in Poplar Bluff, MO · General Acute Care 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 Apr 20, 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.