NPIMap

Mercy Hospital Waldron

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Waldron, AR

NPI 1912978685 · NPPES record last updated Feb 17, 2021

Key facts

NPI
1912978685
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
AR4196 (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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 2

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same 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.

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

Facilities with the same owner 115

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

View all 115

Practitioners 12

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

Affiliated clinicians 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AR

Hospital certification: CCN 04Z305

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

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 Officer
Secretary		 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 Officer
President		 Apr 10, 2012
Elizabeth Maddox
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Yogya Regmi
Individual 		W-2 Managing Employee
Director		 Aug 29, 2022
Michael Keith Gibbons
Individual 		Corporate Director
Board Member		 Jul 1, 2022
Edward Melton
Individual 		Corporate Director
Board Member		 Jul 1, 2024
Bret Cook
Individual 		Corporate Director
Board 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 Director
Board 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 Officer
Treasurer		 Jan 1, 2021
W-2 Managing Employee
VP Finance		 Jan 1, 2021
Vicky Laird
Individual 		Corporate Director Jul 1, 2021

Medicare enrollment records

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

National Provider Directory

Tax ID family
Mercy Hosp Scott Cnty (3 organizations share this tax ID)

Specialties & licenses

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

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 17, 2021.

{
    "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

All providers in Waldron, AR · Medicare Defined Swing Bed Hospital Unit in Arkansas

Sources for this page

Verify at the official NPI Registry.