NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center LLC

  • Rural Health Clinic/Center
  • Malden, MO
National Provider Identifier
1801839147
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Practice address
806 N Douglass St
Malden, MO 63863-1512
Phone
(573) 276-3873
NPI assigned
Jun 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

806 N Douglass St
Malden, MO 63863-1512

Mailing address

806 N Douglass St
Malden, MO 63863-1512
Phone (573) 276-3873

Other identifiers 1

IdentifierTypeStateIssuer
593650005MedicaidMO

Other names 1

  • Malden 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
O20030829000032 MO Part A Provider - Rural Health Clinic 6800707225 Practice locations: Malden, MO

Rural health clinic certification: CCN 263996

Legal name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
MALDEN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 13, 1993
Last certification
Oct 22, 2019
Ownership / control type
1B
Most recent change of ownership
Nov 1, 2003 (2 total)
Organization structure
LLCProprietary
Incorporated
Apr 14, 2009 in MO
Enrollment address
806 N Douglass St
Malden, MO 63863-1512
Related CCNs
260119

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Poplar Bluff Regional Medical Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

215 W Grant St
Dexter, MO 63841
Phone (573) 624-7491

2588 N Westwood Blvd
Ste B
Poplar Bluff, MO 63901
Phone (573) 778-1277

Ownership & related parties

All disclosed owners & managing parties 16

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 Jan 27, 2014
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual OtherVP Revenue Management Jul 15, 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
Health Management Associates LLC Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 99%
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Central States Hma Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Jan 27, 2014 100%
Bryan Clyde Wood Individual W-2 Managing EmployeeCeo Jul 30, 2024
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Health Management Associates LP Organization, Franklin, TN 5% Or Greater Indirect Ownership Interest Jan 27, 2014 99%
Paula M Lalor Individual Corporate DirectorDirector PFS Apr 1, 2017
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary Jan 27, 2014
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 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 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1801839147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 N DOUGLASS ST",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "638631512",
            "telephone_number": "573-276-3873",
            "fax_number": "573-276-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 N DOUGLASS ST",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "638631512",
            "telephone_number": "573-276-3873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "593650005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malden Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malden, MO

Sources for this page

Verify at the official NPI Registry.