NPIMap

Organization Active NPI

Moberly Hospital Company LLC

Doing business as Chariton Valley Family Medicine

  • Rural Health Clinic/Center
  • Salisbury, MO
National Provider Identifier
1851713580
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
506-6 Issued in MO
Legal business name
MOBERLY HOSPITAL COMPANY LLC
Doing business as
Chariton Valley Family Medicine
Practice address
413 W 2ND St
Salisbury, MO 65281-1405
Phone
(660) 388-7084
Fax
(660) 388-7087
NPI assigned
Jan 15, 2014
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
Rural Health Clinic/Center 261QR1300X 506-6 MO Primary

Addresses

Primary practice location

413 W 2ND St
Salisbury, MO 65281-1405

Mailing address

PO Box 9645
Belfast, MD 04915-9022
Phone (660) 388-7084

Other names 1

  • Chariton Valley 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
O20140507000001 MO Part A Provider - Rural Health Clinic 9436052230 Practice locations: Salisbury, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851713580. Details of each certification follow.

Rural health clinic certification: CCN 268715

Legal name
MOBERLY HOSPITAL COMPANY LLC
Doing business as
CHARITON VALLEY FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 16, 2014
Last certification
Mar 2, 2021
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Oct 29, 2007 in DE
Enrollment address
413 W 2ND St
Salisbury, MO 65281-1405
Related CCNs
260074

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).

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
26D0974044Chariton Valley Family Medicine413 West Second Street, Salisbury, MO 65281Certificate of waiverApr 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Moberly Reg Med Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1706 Prospect Dr
Ste B
Macon, MO 63552
Phone (660) 385-6540

12806 Highway 151
Madison, MO 65263
Phone (660) 291-8636

1750 Omar Bradley Rd
Moberly, MO 65270
Phone (660) 263-8400

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 Jun 1, 2014
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual Corporate DirectorVP 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
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2014 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 Jun 1, 2014 100%
Christopher G Cobb Individual Corporate OfficerVP/Secretary Apr 1, 2017
CHS Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 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 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1851713580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9645",
            "city": "BELFAST",
            "state": "MD",
            "postal_code": "049159022",
            "telephone_number": "660-388-7084",
            "fax_number": "660-388-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 W 2ND ST",
            "city": "SALISBURY",
            "state": "MO",
            "postal_code": "652811405",
            "telephone_number": "660-388-7084",
            "fax_number": "660-388-7087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBERLY HOSPITAL COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "506-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chariton Valley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chariton Valley Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salisbury, MO

Sources for this page

Verify at the official NPI Registry.