NPIMap

Organization Active NPI

Moberly Hospital Company LLC

Doing business as Moberly Regional Medical Center

  • General Acute Care Hospital
  • Moberly, MO
National Provider Identifier
1770554305
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
423-9 Issued in MO
Legal business name
MOBERLY HOSPITAL COMPANY LLC
Doing business as
Moberly Regional Medical Center
Practice address
1515 Union Ave
Moberly, MO 65270-9407
Phone
(660) 263-8400
NPI assigned
Jan 31, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Authorized official

Name
Paula M Lalor
Title
Director / Delegated Official
Phone
(629) 215-3953

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 423-9 MO Primary

Addresses

Primary practice location

1515 Union Ave
Moberly, MO 65270-9407

Mailing address

PO Box 60856
Saint Louis, MO 63160-0856

Other identifiers 6

IdentifierTypeStateIssuer
652700000OtherCHAMPUS
114OtherBCBS
103184OtherUNITED HEALTHCARE
5020191OtherPHP
011435005MedicaidMO
006895400OtherBLACK LUNG

Other names 1

  • Moberly Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051017000412 MO Part A Provider - Hospital 9436052230 Practice locations: Moberly, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770554305. Details of each certification follow.

Hospital certification: CCN 260074

Legal name
MOBERLY HOSPITAL COMPANY LLC
Doing business as
MOBERLY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 1, 2012
Beds
101 (15 certified)
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Oct 29, 2007 in DE
Enrollment address
1515 Union Ave
Moberly, MO 65270-9407
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Moberly Regional Medical CenterCCN 260074 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
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 13

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

NameRoleSinceShare
Kevin J Hammons Individual Corporate OfficerPresident/Board Member Feb 27, 2012
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual Corporate DirectorVP Revenue Management Jul 14, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Dec 31, 2007 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Michael D Hall Individual W-2 Managing EmployeeCeo Jun 25, 2022
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Paula M Lalor Individual Corporate DirectorDirector/Delegated Official Apr 1, 2017
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Community Health Investment Company LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Dec 31, 2007 100%
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 1, 2017
CHS Community Health Systems Inc Organization, Franklin, TN Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Dec 31, 2007 100%

Facilities with the same owner 120

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

View all 120

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 165

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

View all 165

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1770554305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60856",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631600856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 UNION AVE",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652709407",
            "telephone_number": "660-263-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBERLY HOSPITAL COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR / DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MO",
            "license": "423-9",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "652700000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "114",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "103184",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "5020191",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011435005",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "006895400",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moberly Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moberly Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moberly, MO

Sources for this page

Verify at the official NPI Registry.