NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc.

Doing business as Fitzgibbon Radiology Group

  • Diagnostic Radiology Physician
  • Marshall, MO
National Provider Identifier
1750155818
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC.
Doing business as
Fitzgibbon Radiology Group
Practice address
2305 S Highway 65
Marshall, MO 65340-3702
Phone
(660) 886-7431
NPI assigned
Nov 9, 2023
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

2305 S Highway 65
Marshall, MO 65340-3702

Mailing address

2305 S Highway 65
Marshall, MO 65340-3702
Phone (660) 886-7431

Other names 1

  • Fitzgibbon Radiology Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231120001012 MO Part B Supplier - Clinic/Group Practice 2567351570 Receives reassigned benefits from 2 practitioners
Practice locations: Marshall, MO

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Grandriver Medical Clin9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Fitzgibbon HospitalMarshall, MO, CCN 260142 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 1966
Jul 1, 1966
Fitzgibbon HospitalMarshall, MO, CCN 26S142 Hospital Operational/Managerial Control (100%) Jul 1, 1966
The Living CenterMarshall, MO, CCN 265688 Skilled nursing facility Operational/Managerial Control (10%) Jul 5, 1995
Fitzgibbon Professional BuildingMarshall, MO, CCN 268577 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 1996
Jun 1, 1996
Akeman McBurney Health ClinicSlater, MO, CCN 268671 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 16, 2012
Nov 1, 2010
Fitzgibbon Family HealthFayette, MO, CCN 268731 Rural health clinic Operational/Managerial Control Aug 1, 2014
Mid-Missouri Family Health at FitzgibbonMarshall, MO, CCN 268789 Rural health clinic Operational/Managerial Control Apr 1, 2020
Pilot Grove Medical Clinic at FitzgibbonPilot Grove, MO, CCN 268790 Rural health clinic Operational/Managerial Control Jan 1, 2022

Owned or controlled facilities with NPI records 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1699488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1750155818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 S HIGHWAY 65",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 S HIGHWAY 65",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-09",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7431"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitzgibbon Radiology Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.