NPIMap

Organization Active NPI

Hannibal Regional Healthcare System, Inc

  • Rural Health Clinic/Center
  • Monroe City, MO
National Provider Identifier
1912926429
Registry record updated Nov 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
Practice address
821 US Highway 24 and 36 E
Monroe City, MO 63456-1470
Phone
(573) 735-2506
Fax
(573) 735-1083
NPI assigned
Jul 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2014

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

Authorized official

Name
Roger J Dix
Title
Cfo
Phone
(573) 248-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

821 US Highway 24 and 36 E
Monroe City, MO 63456-1470

Mailing address

6000 Hospital Dr
Hannibal, MO 63401-6887
Phone (573) 248-1300

Other identifiers 1

IdentifierTypeStateIssuer
598962108MedicaidMO

Other names 1

  • Monroe City Family Practice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080118000468 MO Part A Provider - Rural Health Clinic 1254236300 Practice locations: Monroe City, MO

Rural health clinic certification: CCN 268513

Legal name
HANNIBAL REGIONAL HEALTHCARE SYSTEM INC
Doing business as
MONROE CITY FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 11, 1997
Last certification
Jun 5, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 6, 1965 in MO
Enrollment address
821 US Hwy 24 and 36 E
Monroe City, MO 63456-1470
Related CCNs
260025

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

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Hannibal Regional Healthcare System Inc Organization, Hannibal, MO Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2014 100%
Operational/Managerial Control Apr 1, 2014 100%
Robert N Gasaway Individual Corporate OfficerVP of Finance Feb 9, 2017
W-2 Managing EmployeeVP of Finance Feb 9, 2017
Christopher T Ahrens Individual Corporate OfficerCeo Apr 1, 2014 100%
W-2 Managing EmployeeCeo Apr 1, 2014 100%
Operational/Managerial ControlCeo Apr 1, 2014 100%

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Hannibal Regional HospitalHannibal, MO, CCN 260025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Inpatient RehabilitationHannibal, MO, CCN 26T025 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 20, 2014
Apr 1, 2014
Hannibal Regional Hospital Home Health AgencyHannibal, MO, CCN 267282 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 22, 2012
Feb 6, 2017
Shelbina Family PracticeShelbina, MO, CCN 268512 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Canton-Lagrange Family PracticeCanton, MO, CCN 263984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 3, 1992
Apr 30, 1992
Pike Medical ClinicLouisiana, MO, CCN 268723 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical Group-Bowling GreenBowling Green, MO, CCN 268724 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2014
Apr 1, 2014
Hannibal Regional Medical GroupHannibal, MO, CCN 268754 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016
Express Care at WalmartHannibal, MO, CCN 268759 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Nov 1, 2016
Oct 1, 2012
Complete Family Medicine Lancaster RHCLancaster, MO, CCN 268757 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine la Plata RHCLa Plata, MO, CCN 268756 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017
Complete Family Medicine Kirksville RHCKirksville, MO, CCN 268758 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 3, 2017
Jul 3, 2017

National Provider Directory

National Provider Directory
Tax ID family
Center Family Practice33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Owners & managing parties with NPI records 15

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

View all 15

Owned or controlled facilities with NPI records 12

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

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Facilities with the same owner 12

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

Practitioners 256

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 256

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416441600000",
    "number": "1912926429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016887",
            "telephone_number": "573-248-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 US HIGHWAY 24 AND 36 E",
            "city": "MONROE CITY",
            "state": "MO",
            "postal_code": "634561470",
            "telephone_number": "573-735-2506",
            "fax_number": "573-735-1083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-11-20",
        "status": "A",
        "authorized_official_last_name": "DIX",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-248-1300"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598962108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe City Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe City, MO

Sources for this page

Verify at the official NPI Registry.