Macon County Samaritan Hospital
Organization Active NPI Rural Health Clinic/Center · Macon, MO
NPI 1891734505 · NPPES record last updated Feb 9, 2015
Key facts
- NPI
- 1891734505
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- N/A - HOSPITAL BASED
- Legal business name
- MACON COUNTY SAMARITAN HOSPITAL
- Practice address
- 1201 N Rutherford St
Macon, MO 63552-2020 - Phone
- (660) 385-8900
- Fax
- (660) 385-8708
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Susan J Spencer, CPA
- Title
- Cfo
- Phone
- (660) 385-8716
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 2
Practitioners 37
-
Thomas A Bragg, D.O.
-
Julie L Burdin, MD
-
Lisa Michelle Mayes, D.O.
-
James W McDowell, MD
-
Tysen J Petre, D.O.
-
Emily Kerns, PA
-
Francisco Aleman, MD
-
Samir S Ashraf, D.O.
-
Angela Coleen Moore Clay, D.O.
-
James L Deline, M.D.
-
Angelee Michelle Geisler, C.N.P.
-
Luvell Leigh Glanton Jr., M.D.
-
Robert Wayne Jackson, D.O.
-
Deborah Joy Manning, M.D.
-
Jorge Margiela, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D1015512 | Total Family Health Care | Provider-performed microscopy | Feb 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Rural health clinic certification: CCN 268567
- Legal name
- MACON COUNTY SAMARITAN HOSPITAL
- Doing business as
- TOTAL FAMILY HEALTH CARE A DIVISION OF SAMARITAN HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 31, 2003
- Last certification
- Jan 14, 2020
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Non-profit
- Incorporated
- in MO
- Enrollment address
- 1201 N Rutherford St
Macon, MO 63552-2020 - Related CCNs
- 261313
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Macon County Samaritan Hospital |
Operational/Managerial Control | Jul 31, 2003 | |
| Jill E Williams |
W-2 Managing Employee |
Jan 1, 2020 | |
| Other | Jan 1, 2020 | ||
| Carli Taylor |
W-2 Managing Employee |
Jan 1, 2020 | |
| Operational/Managerial Control |
Jan 1, 2020 | ||
| Keith Maloney |
Corporate Officer | Apr 3, 2013 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Samaritan Hospital |
Hospital | Operational/Managerial Control (100%) | Aug 1, 1986 |
| Samaritan Hospital |
Hospital | Operational/Managerial Control (100%) | Aug 1, 1986 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030708000012 | MO | Part a Provider - Rural Health Clinic | 1456261395 | Practice locations: Macon, MO |
| O20040622000847 | MO | Part B Supplier - Clinic/Group Practice | 1456261395 |
Receives reassigned benefits from 11 practitioners Practice locations: Macon, MO |
National Provider Directory
Locations
1201 N Rutherford St
Macon, MO 63552
Phone (660) 385-8700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital Clinic/Center | 261QC0050X | N/A - HOSPITAL BASED | ||
| Rural Health Clinic/Center | 261QR1300X | N/A - HOSPITAL BASED | Yes |
Addresses
Primary practice location
1201 N Rutherford St
Macon, MO 63552-2020
Mailing address
1205 N Missouri St
Macon, MO 63552-2095
Phone (660) 385-8700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 596088104 | Medicaid | MO | |
| 505973701 | Other | MO | MEDICAID MO |
| DA1450 | Other | MO | RAILROAD MEDICARE |
| 000013920 | Other | MO | MEDICARE MO |
Other names
- Total Family Healthcare
Other providers in Macon, MO
- Macon County Samaritan Hospital
- Macon County Samaritan Hospital
- Macon County Samaritan Hospital
- Macon County Samaritan Hospital
- Macon County Samaritan Hospital
- Macon County Samaritan Hospital
- Macon County Sheltered Workshop
- Macon Rehabilitation Services, LLC
- Mark Vincent Maddox
- Donet Christopher Main
All providers in Macon, MO · Rural Health Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.