NPIMap

Organization Active NPI

Mercy Health-Marcum & Wallace Hospital LLC

Doing business as Mercy Health Marcum & Wallace Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Irvine, KY
National Provider Identifier
1902895964
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
600052 Issued in KY
Legal business name
MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC
Doing business as
Mercy Health Marcum & Wallace Hospital
Practice address
60 Mercy CT
Irvine, KY 40336-1331
Phone
(270) 444-2163
Fax
(270) 444-2460
NPI assigned
Oct 20, 2005
Last updated
May 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Authorized official

Name
Ms. Trena Stocker
Title
President
Phone
(859) 779-0148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 600052 KY Primary

Addresses

Primary practice location

60 Mercy CT
Irvine, KY 40336-1331

Mailing address

PO Box 636544
Cincinnati, OH 45263-6544
Phone (270) 444-2163

Other identifiers 1

IdentifierTypeStateIssuer
12700324MedicaidKY

Other names 1

  • Mercy Health Marcum & Wallace Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080418000427 KY Part A Provider - Critical Access Hospital 6901799386 Practice locations: Irvine, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902895964. Details of each certification follow.

Hospital certification: CCN 18Z301

Legal name
MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC
Organization structure
LLCNon-profit
Incorporated
Sep 30, 1977 in KY
Enrollment address
60 Mercy CT
Irvine, KY 40336-1331
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Marcum Wallace Memori5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Scotty Dwayne Combs Individual Corporate DirectorBoard Member Jan 1, 2024
Justin Dixon Individual Corporate DirectorBoard Member Mar 1, 2015
Trena Lynn Stocker Individual Corporate OfficerPresident Apr 28, 2019
Corporate DirectorBoard Member Apr 28, 2019
W-2 Managing EmployeePresident Apr 28, 2019
Michael J Yungmann Individual Corporate OfficerMarket President Jan 9, 2017
Corporate DirectorBoard Member Jan 9, 2017
Maher Kassis Individual Corporate DirectorBoard Member Mar 1, 2014
Joe Crawford Individual Corporate DirectorBoard Member Jan 1, 2022
Patricia M Rice Individual Corporate DirectorBoard Member Mar 1, 2008
Kevin Williams Individual Corporate DirectorBoard Member Jan 1, 2020
Bon Secours Mercy Health Inc Organization, Cincinnati, OH Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2018 100%
John Starcher Individual Operational/Managerial ControlCho Admin Mar 16, 2016
Ethan Witt Individual Corporate DirectorBoard Member Jan 1, 2022
Kayla Carroll Individual Corporate DirectorBoard Member Jan 1, 2024
Ethan Moore Individual Corporate DirectorBoard Member Jan 1, 2024
Regina Robertson Individual Corporate DirectorBoard Member Jan 1, 2023
Mercy Health-Lourdes Hospital LLC Organization, Paducah, KY Non-profit 5% Or Greater Direct Ownership Interest Jul 13, 2000 100%
Marty Snowden Individual Corporate DirectorBoard Member Jan 1, 2024
Andrea Springer Individual Corporate DirectorBoard Member Jan 1, 2025
Kimberly M Ralston Individual W-2 Managing EmployeeVP Reimbursement Oct 7, 2017
Sandy Dunahoo Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mercy Health - Irvine Primary CareIrvine, KY, CCN 183462 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2010
Mercy Health - Powell County Primary CareClay City, KY, CCN 183475 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2012

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 97

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

View all 97

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1902895964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636544",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636544",
            "telephone_number": "270-444-2163",
            "fax_number": "270-444-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MERCY CT",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "403361331",
            "telephone_number": "270-444-2163",
            "fax_number": "270-444-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH-MARCUM & WALLACE HOSPITAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "STOCKER",
        "authorized_official_first_name": "TRENA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-779-0148",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "KY",
            "license": "600052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12700324",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Health Marcum & Wallace Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, KY

Sources for this page

Verify at the official NPI Registry.