NPIMap

Madison Medical Center Stockhoff Memorial Nursing Home

Organization Active NPI Critical Access Hospital · Fredericktown, MO

NPI 1720163025 · NPPES record last updated Jun 25, 2008

Key facts

NPI
1720163025
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
License
209-45 (MO)
Legal business name
MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME
Practice address
611 W Main St
Fredericktown, MO 63645-1111
Phone
(573) 783-3341
Fax
(573) 783-1096
NPI assigned
Oct 26, 2006
Organization subpart
No

Authorized official

Name
Ms. Lisa Marie Twidwell
Title
Cfo
Phone
(573) 783-3341

Owned or controlled facilities with NPI records 1

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

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

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

Affiliated clinicians 63

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

View all 63

Medicare Care Compare: Hospital

Listed as
Madison Medical Center CCN 261302
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Hospital certification: CCN 261302

Legal name
MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME
Doing business as
MADISON MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2000
Last certification
Apr 3, 2024
Beds
25
Ownership / control type
Other
Organization structure
Government · Non-profit
Enrollment address
611 W Main St
Fredericktown, MO 63645-1111

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kent Marler
Individual 		Corporate Director Jun 12, 2008
Lisa M Twidwell
Individual 		Corporate Officer
Ceo		 Jun 1, 2009 100%
W-2 Managing Employee Jun 12, 2008

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Madison Medical Center
Fredericktown, MO · CCN 268568		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2003
Apr 1, 2003

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031118000558 MO Part B Supplier - Clinic/Group Practice 1355255886 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
Practice locations: Fredericktown, MO
O20080723000675 MO Part a Provider - Critical Access Hospital 1355255886 Receives reassigned benefits from 27 practitioners
Practice locations: Fredericktown, MO

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 209-45 MO Yes

Addresses

Primary practice location

611 W Main St
Fredericktown, MO 63645-1111

Mailing address

611 W Main St
PO Box 431
Fredericktown, MO 63645-1111
Phone (573) 783-3341

Other identifiers

IdentifierTypeStateIssuer
010155109MedicaidMO

Other names

  • MADISON MEMORIAL HOSPITAL Former legal business name

Other providers in Fredericktown, MO

All providers in Fredericktown, MO · Critical Access Hospital in Missouri

Sources for this page

Verify at the official NPI Registry.