NPIMap

Organization Active NPI

Mercy Hospital Waldron

  • Medicare Defined Swing Bed Hospital Unit
  • Waldron, AR
National Provider Identifier
1912978685
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
AR4196 Issued in AR
Legal business name
MERCY HOSPITAL WALDRON
Practice address
1341 W 6TH St
Waldron, AR 72958-7642
Phone
(479) 314-6100
Fax
(479) 314-1770
NPI assigned
Jan 30, 2006
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Sherry Lynn Clouse Day
Title
VP Finance Mercy Cah
Phone
(417) 820-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X AR4196 AR Primary

Addresses

Primary practice location

1341 W 6TH St
Waldron, AR 72958-7642

Mailing address

7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone (479) 314-6100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061221000032 AR Part A Provider - Critical Access Hospital 5597658005 Practice locations: Waldron, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912978685. Details of each certification follow.

Hospital certification: CCN 04Z305

Legal name
MERCY HOSPITAL WALDRON
Organization structure
CorporationNon-profit
Incorporated
Mar 30, 1982 in AR
Enrollment address
1341 West 6TH Street
Waldron, AR 72958-7642
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Twin Cities Medical Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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.

Locations

1341 W 6th St
Waldron, AR 72958
Phone (479) 637-2136

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
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Mercy Health Fort Smith Communities Organization, Fort Smith, AR Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Nov 12, 2007 100%
Ryan Gehrig Individual Corporate OfficerPresident Apr 10, 2012
Elizabeth Maddox Individual Corporate DirectorBoard Member Jul 1, 2024
Yogya Regmi Individual W-2 Managing EmployeeDirector Aug 29, 2022
Michael Keith Gibbons Individual Corporate DirectorBoard Member Jul 1, 2022
Edward Melton Individual Corporate DirectorBoard Member Jul 1, 2024
Bret Cook Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Hospital Fort Smith Organization, Fort Smith, AR Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Nov 13, 2007 100%
Martha Ullrich Individual Corporate Director Jul 1, 2021
Allen Ray Individual Corporate DirectorBoard Member Jul 1, 2024
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Nov 13, 2007 100%
Carol Corley Individual Corporate Director Jul 1, 2021
Judith Marie Keith Individual Corporate Director Jul 1, 2021
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP Finance Jan 1, 2021
Vicky Laird Individual Corporate Director Jul 1, 2021

Owners & managing parties with NPI records 2

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

Facilities with the same owner 115

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

View all 115

Practitioners & affiliated clinicians

Practitioners 9

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 1

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": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1912978685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034100",
            "telephone_number": "479-314-6100",
            "fax_number": "479-314-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1341 W 6TH ST",
            "city": "WALDRON",
            "state": "AR",
            "postal_code": "729587642",
            "telephone_number": "479-314-6100",
            "fax_number": "479-314-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL WALDRON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP FINANCE MERCY CAH",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AR",
            "license": "AR4196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldron, AR

Sources for this page

Verify at the official NPI Registry.