NPIMap

Organization Active NPI

Salem Memorial Hospital

Doing business as SMDH Family Medicine

  • Rural Health Clinic/Center
  • Salem, MO
National Provider Identifier
1821243981
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SALEM MEMORIAL HOSPITAL
Doing business as
SMDH Family Medicine
Practice address
35629 Hwy 72
BLD. 3
Salem, MO 65560-0719
Phone
(573) 729-8000
Fax
(573) 729-8001
NPI assigned
Nov 17, 2008
Last updated
Apr 7, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
SALEM MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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

Authorized official

Name
Brooke Bollman
Title
Ceo
Phone
(573) 739-1927

Specialties & licenses 1

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

Addresses

Primary practice location

35629 Hwy 72
BLD. 3
Salem, MO 65560-0719

Mailing address

35629 Highway 72 BLDG 3
Salem, MO 65560-7217
Phone (573) 729-8000

Other names 1

  • SMDH Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090602000202 MO Part A Provider - Rural Health Clinic 7012801129 Practice locations: Salem, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821243981. Details of each certification follow.

Rural health clinic certification: CCN 268634

Legal name
SALEM MEMORIAL HOSPITAL
Doing business as
SMDH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 11, 2009
Last certification
Sep 19, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
in MO
Enrollment address
35629 Highway 72 BLDG 3
Salem, MO 65560-7217
Related CCNs
261318

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

Other NPIs with the same Medicare PAC ID 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D1093439SMDH Family Medicine35629 Highway 72, Salem, MO 65560Provider-performed microscopyDec 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Salem Memorial Hosp5 organizations share this tax ID, including this one
Part of
Salem Memorial Hosp

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Karen Brown Individual Corporate DirectorBoard Member Jan 1, 2024
Amber a. Hogan Individual W-2 Managing EmployeeChief Nursing Officer Jan 1, 2024
Leigh a Price Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Swyers Individual Corporate DirectorBoard Member Jan 1, 2020
Salem Memorial Hospital Organization, Salem, MO Operational/Managerial Control Jan 19, 2009
Frank Barnitz Individual Corporate DirectorBoard Member Jan 1, 2024
Zach Moser Individual Corporate DirectorBoard Member Jan 1, 2023
Brooke Bollman Individual Corporate OfficerCeo Jan 1, 2024
Corporate DirectorCeo Jan 1, 2024
W-2 Managing EmployeeChief Executive Officer Jan 1, 2024

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Salem Memorial HospitalSalem, MO, CCN 26Z318 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Sep 1, 1970
Sep 1, 1970

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775520000000",
    "number": "1821243981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35629 HIGHWAY 72 BLDG 3",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655607217",
            "telephone_number": "573-729-8000",
            "fax_number": "573-729-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35629 HWY 72",
            "address_2": "BLD. 3",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655600719",
            "telephone_number": "573-729-8000",
            "fax_number": "573-729-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALEM MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SALEM MEMORIAL HOSPITAL",
        "enumeration_date": "2008-11-17",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A",
        "authorized_official_last_name": "BOLLMAN",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-739-1927"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMDH Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, MO

Sources for this page

Verify at the official NPI Registry.