NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center, LLC

Doing business as Poplar Bluff Medical Clinic

  • Rural Health Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1881965267
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
Doing business as
Poplar Bluff Medical Clinic
Practice address
2588 N Westwood Blvd
Poplar Bluff, MO 63901-2535
Phone
(573) 277-8127
Fax
(573) 778-1299
NPI assigned
Jan 18, 2012
Last updated
Apr 20, 2021By the provider in NPPES
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 NU Primary

Addresses

Primary practice location

2588 N Westwood Blvd
Poplar Bluff, MO 63901-2535

Mailing address

2588 N Westwood Blvd
Poplar Bluff, MO 63901-2339

Other names 1

  • Poplar Bluff Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090911000300 MO Part B Supplier - Clinic/Group Practice 6800707225 Receives reassigned benefits from 14 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Poplar Bluff, MO; Dexter, MO; Malden, MO; Bloomfield, MO
O20121030000465 MO Part A Provider - Rural Health Clinic 6800707225 Practice locations: Poplar Bluff, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881965267. Details of each certification follow.

Rural health clinic certification: CCN 268676

Legal name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
POPLAR BLUFF MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 20, 2012
Last certification
May 27, 2026
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Apr 14, 2009 in MO
Enrollment address
2588 N Westwood Blvd
Poplar Bluff, MO 63901-2339
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).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

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 Corporate DirectorVP Revenue Management Jul 14, 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%
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Health Management Associates LP Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Jan 27, 2014 99%
Eric Naegler Individual W-2 Managing EmployeeCeo Jun 12, 2021
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.

  • Kirksville Missouri Hospital Company LLC

    dba Northeast Regional Medical Group

    • Rural Health Clinic/Center
    • Kirksville, MO
    • NPI 1508135005

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • General Acute Care Hospital
    • Kirksville, MO
    • NPI 1104899442

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Kirksville, MO
    • NPI 1932172293

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Moberly, MO
    • NPI 1346212784

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Psychiatric Hospital Unit
    • Moberly, MO
    • NPI 1366413882

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Rural Health Clinic

    • Rural Health Clinic/Center
    • Moberly, MO
    • NPI 1407989510

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • General Acute Care Hospital
    • Moberly, MO
    • NPI 1770554305

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Chariton Valley Family Medicine

    • Rural Health Clinic/Center
    • Salisbury, MO
    • NPI 1851713580

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Puxico Medical Clinic

    • Rural Health Clinic/Center
    • Puxico, MO
    • NPI 1275576654

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Dexter Medical Center

    • Rural Health Clinic/Center
    • Dexter, MO
    • NPI 1700821212

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Poplar Bluff Regional Medical Center

    • General Acute Care Hospital
    • Poplar Bluff, MO
    • NPI 1700831724

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Malden Medical Center

    • Rural Health Clinic/Center
    • Malden, MO
    • NPI 1801839147

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
View all 120

NPI Registry JSON

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1881965267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2588 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2588 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012535",
            "telephone_number": "573-277-8127",
            "fax_number": "573-778-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Bluff Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.