Ste Genevieve County Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Ste Genevieve, MO
NPI 1801817416 · NPPES record last updated Jan 13, 2023
Key facts
- NPI
- 1801817416
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
- Practice address
- 753 Pointe Basse Dr
Ste Genevieve, MO 63670-1820 - Phone
- (573) 883-2782
- NPI assigned
- Jul 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Amanda Wolk
- Title
- Business Office Director
- Phone
- (573) 883-7703
Owners & managing parties with NPI records 8
Owned or controlled facilities with NPI records 7
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 8
Facilities with the same owner 7
Practitioners 99
-
Jared R Arnett, PMHNP
-
Naeem Aslam, MD
-
Matthew S Bosner, MD
-
Kimberly L Browne, ANP
-
Zaki Hossain Chowdhury, M.D.
-
Mary Elizabeth Crecelius, WHNP
-
Rebecca Jean Dalton, MSN, PMHNP-BC
-
Kelly A Donze, CNM, WHNP
-
Dan Frissell, MD
-
Lisa Gibbs, FNP
-
Gary R Goldstein, M.D.
-
Kelly Renee Grein, APRN-FNP-C
-
Elle Grither, MSN, APRN, FNP-BC
-
Sandra Hoffmann, M.D.
-
Holly A Huelskamp, FNP
-
Branda Irvin, FNP-C
-
Deniane John, MD
-
Erika Leung, M.D.
-
Samuel Mearl Medaris, M.D.
-
Stephanie Moll, APRN-FNP-BC
-
Azra Niaz, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Rural health clinic certification: CCN 268580
- Legal name
- STE GENEVIEVE COUNTY MEMORIAL HOSPITAL
- Doing business as
- FAMILY HEALTH CARE POINTE BASSE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 2, 2004
- Last certification
- Oct 24, 2024
- Ownership / control type
- Non-profit – church related
- Most recent change of ownership
- Apr 3, 2004 (1 total)
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 1, 1969 in MO
- Enrollment address
- 753 Pointe Basse Dr
Sainte Genevieve, MO 63670-1820
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Tracy a Bonnell |
Corporate Director |
Sep 1, 2023 | |
| W-2 Managing Employee | Sep 1, 2023 | ||
| Rachel L Dallas |
W-2 Managing Employee | Apr 1, 2022 | |
| Amanda Wolk |
Corporate Director |
Mar 1, 2015 | |
| Ste Genevieve County Memorial Hospital |
5% Or Greater Direct Ownership Interest | Apr 1, 2004 | 100% |
| Operational/Managerial Control | Apr 1, 2004 | 100% | |
| John Schmidt |
Corporate Officer |
May 1, 2023 | |
| Ann L Gegg |
W-2 Managing Employee | Aug 14, 2020 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Ste Genevieve County Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1969 |
| Ste Genevieve County Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Apr 1, 1969 |
| Pine Drive Medical Centre |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Apr 2, 2004 |
| Apple Kids Pediatrics |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jan 8, 1996 Jan 8, 1997 |
| Women'S Health Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 2, 2008 Jun 1, 2008 |
| Bloomsdale Family Health Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Nov 1, 2000 Nov 1, 2000 |
| Plaza Family Health Care |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040617000089 | MO | Part B Supplier - Clinic/Group Practice | 3274432802 |
Receives reassigned benefits from 67 practitioners 1 other NPI on this enrollment Practice locations: Ste Genevieve, MO |
| O20100212000705 | MO | Part a Provider - Rural Health Clinic | 3274432802 | Practice locations: Sainte Genevieve, MO |
National Provider Directory
Locations
753 Pointe Basse Dr
Ste Genevieve, MO 63670
Phone (573) 883-2782
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MO | Yes |
Addresses
Primary practice location
753 Pointe Basse Dr
Ste Genevieve, MO 63670-1820
Mailing address
PO Box 366
Ste Genevieve, MO 63670-0366
Phone (573) 883-2782
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CC8331 | Other | MO | RAILROAD MEDICARE |
Other names
- FAMILY HEATH CARE POINTE BASSE
- Family Health Care Pointe Basse
- Pointe Basse Family Health Center
Other providers in Ste Genevieve, MO
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital
- Ste Genevieve County Memorial Hospital SG MH Pharmacy
- Ste Genevieve Group Home Inc.
- Ste Genevieve Residential, LLC
All providers in Ste Genevieve, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.