NPIMap

Organization Active NPI

Regional Med Extended Care Hospital, LLC

Doing business as Regional One Health Extended Care Hospital

  • Long Term Care Hospital
  • Memphis, TN
National Provider Identifier
1790197945
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
186 Issued in TN
Legal business name
REGIONAL MED EXTENDED CARE HOSPITAL, LLC
Doing business as
Regional One Health Extended Care Hospital
Practice address
890 Madison Ave
4TH Floor
Memphis, TN 38103-3409
Phone
(901) 515-3000
NPI assigned
May 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Mark Kelly
Title
Administrator
Phone
(901) 515-3030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 186 TN Primary

Addresses

Primary practice location

890 Madison Ave
4TH Floor
Memphis, TN 38103-3409

Mailing address

890 Madison Ave
4TH Floor
Memphis, TN 38103-3409
Phone (901) 515-3000

Other names 1

  • Regional One Health Extended Care Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140707002200 TN Part A Provider - Hospital 9133226970 Practice locations: Memphis, TN

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1790197945. Details of each certification follow.

Hospital certification: CCN 442017

Legal name
REGIONAL MED EXTENDED CARE HOSPITAL, LLC
Doing business as
REGIONAL ONE HEALTH EXTENDED CARE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Feb 3, 2014
Last certification
Sep 15, 2021
Beds
30
Ownership / control type
Private (not for profit)
Organization structure
LLCProprietary
Enrollment address
890 Madison Avenue
4TH Floor
Memphis, TN 38103-3409
Main/Primary Hospital Location
Hospital subgroups
Long-term

Hospital certification: CCN 440234

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
REGIONAL ONE HEALTH EXTENDED CARE HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Aug 10, 2014
Provider type (POS)
Hospital – Short-term
Participating since
Feb 3, 2014
Last certification
Feb 3, 2014
Beds
24
Ownership / control type
Private (not for profit)
Facility address
890 Madison Avenue 4TH Floor
Memphis, TN 38103

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Regional One Health Extended Care HospitalCCN 442017 · All quality measures
Ownership
Non-profit
Certified
Feb 3, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Beds
30

National Provider Directory

National Provider Directory
Tax ID family
Memphis Long Term Care Specialty Hospital LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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.

Member organizations 1

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Phillip Underwood Individual Corporate OfficerChief Executive Officer Sep 25, 2023
W-2 Managing Employee Sep 25, 2023
Shelby County Health Care Corporation Organization, Memphis, TN Non-profit 5% Or Greater Direct Ownership Interest Nov 1, 2013 100%
Thomas Eubank Individual Corporate DirectorBoard Member Apr 4, 2019
Linda F Hughlett Individual Corporate DirectorBoard Member Oct 24, 2022
Muthiah P Muthiah Individual Corporate DirectorBoard Member Apr 22, 2024
Leticia Towns Individual Corporate DirectorBoard Member Jun 12, 2024

Owners & managing parties with NPI records 8

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

Practitioners & affiliated clinicians

Practitioners 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1790197945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 MADISON AVE",
            "address_2": "4TH FLOOR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033409",
            "telephone_number": "901-515-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 MADISON AVE",
            "address_2": "4TH FLOOR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033409",
            "telephone_number": "901-515-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL MED EXTENDED CARE HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-22",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "901-515-3030"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "TN",
            "license": "186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regional One Health Extended Care Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.