NPIMap

Organization Active NPI

Pcrmc-Health Services, Inc.

Doing business as Phelps Health Home Health & Hospice

  • Community Based Hospice Care Agency
  • Rolla, MO
National Provider Identifier
1700913589
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
099-7HO Issued in MO
Legal business name
PCRMC-HEALTH SERVICES, INC.
Doing business as
Phelps Health Home Health & Hospice
Practice address
1500 E State Hwy 72
Rolla, MO 65401-3926
Phone
(573) 364-2425
Fax
(573) 364-3993
NPI assigned
Feb 27, 2007
Last updated
Apr 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Jana Cook
Title
VP, Chief Financial Officer
Phone
(573) 458-7916

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 099-7HO MO Primary

Addresses

Primary practice location

1500 E State Hwy 72
Rolla, MO 65401-3926

Mailing address

1500 E State Hwy 72
Rolla, MO 65401-3926
Phone (573) 364-2425

Other identifiers 1

IdentifierTypeStateIssuer
823992508MedicaidMO

Other names 1

  • Phelps Health Home Health & Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071119000560 MO Part A Provider - Hospice 3577556646 Practice locations: Rolla, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700913589. Details of each certification follow.

Hospice certification: CCN 261583

Legal name
PCRMC-HEALTH SERVICES, INC.
Doing business as
PHELPS HEALTH HOME HEALTH & HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 16, 1999
Last certification
Oct 15, 2021
Ownership / control type
Proprietary - Other
Organization structure
CorporationNon-profit
Incorporated
Jun 11, 1998 in MO
Enrollment address
1500 Hwy 72
Rolla, MO 65401

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Phelps Health Home Health and HospiceCCN 261583 · All quality measures
Ownership
For-Profit
Certified
Mar 16, 1999
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Pcrmc-Health Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Ben Tipton Individual Corporate DirectorDirector Apr 26, 2024
Jason Shenefield Individual Corporate OfficerCeo Jul 21, 2021
W-2 Managing EmployeeCeo Jul 21, 2021
Gregory V Maynard Individual W-2 Managing EmployeeMD; May 1, 2022
Richard Elgin Individual Corporate DirectorDirector Apr 1, 2023
Jana M Cook Individual Corporate OfficerVP-Cfo Jan 1, 2018
Phelps County Regional Medical Center Organization, Rolla, MO Non-profit 5% Or Greater Direct Ownership Interest Jun 11, 1998 100%
Tabatha J Ransom Individual W-2 Managing EmployeeDirector of Home Health / Hospice Nov 29, 2021
Janece Martin Individual Corporate DirectorDirector May 6, 2022
Mary V. Graham Individual Corporate DirectorDirector Apr 23, 2026
Annie Bass Individual Corporate DirectorDirector May 6, 2022

Owners & managing parties with NPI records 9

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1700913589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E STATE HWY 72",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013926",
            "telephone_number": "573-364-2425",
            "fax_number": "573-364-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E STATE HWY 72",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654013926",
            "telephone_number": "573-364-2425",
            "fax_number": "573-364-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCRMC-HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "VP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-458-7916"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "099-7HO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "823992508",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phelps Health Home Health & Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.