NPIMap

Organization Active NPI

Madison Medical Center Stockhoff Memorial Nursing Home

  • Critical Access Hospital
  • Fredericktown, MO
National Provider Identifier
1720163025
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
209-45 Issued in 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
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

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

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
010155109MedicaidMO

Other names 1

  • MADISON MEMORIAL HOSPITAL Former legal business name

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720163025. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
611 W Main St
Fredericktown, MO 63645-1111

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Madison Medical CenterCCN 261302 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

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 OfficerCeo 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 CenterFredericktown, MO, CCN 268568 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2003
Apr 1, 2003

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 39

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 39

Affiliated clinicians 63

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

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1720163025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "address_2": "PO BOX 431",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-3341",
            "fax_number": "573-783-1096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451111",
            "telephone_number": "573-783-3341",
            "fax_number": "573-783-1096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON MEDICAL CENTER STOCKHOFF MEMORIAL NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "TWIDWELL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-783-3341",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MO",
            "license": "209-45",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010155109",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON MEMORIAL HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fredericktown, MO

Sources for this page

Verify at the official NPI Registry.