NPIMap

Organization Active NPI

State of Missouri

Doing business as Southeast MO Mental Health Center

  • Psychiatric Hospital
  • Farmington, MO
National Provider Identifier
1861447526
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF MISSOURI
Doing business as
Southeast MO Mental Health Center
Practice address
1010 W Columbia St
Farmington, MO 63640-2902
Phone
(573) 218-6792
Fax
(573) 218-6703
NPI assigned
May 23, 2006
Last updated
Sep 3, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Molly Jane Boeckmann
Title
Director of Administrative Services
Phone
(573) 751-4055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

1010 W Columbia St
Farmington, MO 63640-2902

Mailing address

1706 E Elm St
Jefferson City, MO 65101-4130
Phone (573) 751-3398

Other identifiers 1

IdentifierTypeStateIssuer
050490200MedicaidMO

Other names 1

  • Southeast MO Mental Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071029000374 MO Part A Provider - Hospital 1456254226 Practice locations: Farmington, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861447526. Details of each certification follow.

Hospital certification: CCN 264005

Legal name
STATE OF MISSOURI
Doing business as
SOUTHEAST MISSOURI MENTAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Jul 29, 1994
Beds
348 (40 certified)
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
1010 W Columbia St
Farmington, MO 63640-2902
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Southeast Missouri Mental HLTH CtrCCN 264005 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Western Missouri Mental Health Center104 organizations share this tax ID, including this one
Part of
Western Missouri Mental Health Center

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Ronald Easter Individual W-2 Managing Employee May 1, 2012
Molly Boeckmann Individual Corporate Director Jul 1, 2020
W-2 Managing Employee Jul 1, 2020
State of Missouri Organization, Jefferson City, MO 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Veera N Reddy Individual W-2 Managing Employee Jan 1, 2006
Gloria Gehlert Individual W-2 Managing EmployeeReimbursement Administrator Jan 9, 2015
Julie Inman Individual W-2 Managing EmployeeRegional Executive Officer Oct 1, 2002
Matthew Roach Individual W-2 Managing Employee Nov 1, 2020
Denise Hacker Individual W-2 Managing Employee Apr 1, 2019
Donna S Siebeneck Individual W-2 Managing EmployeeMedicaid Liasion Oct 1, 2014
Stacy Lynn Neff Individual W-2 Managing Employee Jul 1, 2018

Owners & managing parties with NPI records 13

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

  • Stacy Neff, D.O.
    • Psychiatry Physician
    • Farmington, MO
    • NPI 1639370901

    W-2 Managing Employee

    CMS ownership
  • Veera N. Reddy, M.D.
    • Psychiatry Physician
    • Farmington, MO
    • NPI 1336257237

    W-2 Managing Employee

    CMS ownership
  • State of Missouri

    dba Hawthorn Children's Psychiatric Hosptial

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1033289897

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Fulton State Hospital

    • Psychiatric Hospital
    • Fulton, MO
    • NPI 1104878792

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Northwest MO Psychiatric Rehabilitation Center

    • Psychiatric Hospital
    • Saint Joseph, MO
    • NPI 1104879444

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Fulton State Hospital

    • Psychiatry Physician
    • Fulton, MO
    • NPI 1164477873

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St. Louis Developmental Disabilities Treatment Center

    • General Practice Physician
    • Saint Charles, MO
    • NPI 1316991896

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatry Physician
    • Saint Louis, MO
    • NPI 1427002013

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Southeast MO Mental Health Center

    • Psychiatry Physician
    • Farmington, MO
    • NPI 1437106705

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Center for Behavioral Health

    • Psychiatry Physician
    • Kansas City, MO
    • NPI 1497709083

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1578518239

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Bellefontaine Habilitation Center

    • Physical Medicine & Rehabilitation Physician
    • Saint Louis, MO
    • NPI 1710931167

    5% Or Greater Direct Ownership Interest

    CMS ownership
View all 13

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Center for Behavioral MedicineKansas City, MO, CCN 264008 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
St Louis Forensic Treatment CenterSaint Louis, MO, CCN 264010 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Fulton State HospitalFulton, MO, CCN 264004 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Northwest Missouri Psychiatric Rehabilitation CenterSaint Joseph, MO, CCN 264007 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966
Hawthorn Children's Psychiatric HospitalSaint Louis, MO, CCN 264028 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1981

Owned or controlled facilities with NPI records 5

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

  • State of Missouri

    dba Hawthorn Children's Psychiatric Hosptial

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1033289897

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Fulton State Hospital

    • Psychiatric Hospital
    • Fulton, MO
    • NPI 1104878792

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Northwest MO Psychiatric Rehabilitation Center

    • Psychiatric Hospital
    • Saint Joseph, MO
    • NPI 1104879444

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • State of Missouri

    dba St Louis Forensic Treatment Center

    • Psychiatric Hospital
    • Saint Louis, MO
    • NPI 1578518239

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • State of Missouri

    dba Center for Behavioral Medicine

    • Psychiatric Hospital
    • Kansas City, MO
    • NPI 1730134495

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 5

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1861447526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 E ELM ST",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651014130",
            "telephone_number": "573-751-3398",
            "fax_number": "573-526-4560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W COLUMBIA ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636402902",
            "telephone_number": "573-218-6792",
            "fax_number": "573-218-6703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MISSOURI",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "BOECKMANN",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
        "authorized_official_telephone_number": "573-751-4055"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050490200",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast MO Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southeast MO Mental Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.