John Fitzgibbon Memorial Hospital, Inc.
Organization Active NPI Rural Health Clinic/Center · Brunswick, MO
NPI 1922032549 · NPPES record last updated Mar 5, 2024
Key facts
- NPI
- 1922032549
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 598917607 (MO)
- Legal business name
- JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
- Practice address
- 815 E. Broadway Street
Brunswick, MO 65236-1468 - Phone
- (660) 886-7431
- Fax
- (660) 831-3328
- NPI assigned
- Jul 10, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Authorized official
- Name
- Nancy Harris
- Title
- Cfo/Coo
- Phone
- (660) 886-7431
Owners & managing parties with NPI records 14
-
Darin Lee Haug, DO
-
Jared Karl Romney, D.O.
Other NPIs on the same Medicare enrollment 17
Related certifications (CCN) 4
Affiliated clinicians 130
-
Sadiat Omowunmi Adebiyi, APRN
-
Cary Dean Adkisson, F.N.P.
-
Naser Almasalmeh, M.D.
-
Scott A Anderson, D.O.
-
Abdullah Arshad, MD
-
Jonathan Mark Beary, D.O.
-
Eric D Bettis, DO
-
Brian Bostick, M.D.
-
John Kenneth Boyer, M.D.
-
Blake Jay Brooks, M.D.
-
Richard Brown, MD
-
David P. Brummett, M.D.
-
Kaylea Bultmann, FNP
-
Lynda G Carlyle, FNP
-
Pearl Carrillo, DO
-
Aruna Cheddi, M.D.
-
Yan Chen, MD, PHD
-
Logan Chronister, FNP-BC
-
Justin Robert Cramer, M.D.
-
Michael D Curry, MD, PHD
-
Patricia Lynn Klinger Day, FNP-BC
-
William E Decker, MD
Medicare Care Compare: Hospital
- Listed as
- Fitzgibbon Hospital
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Hospital certification: CCN 260142
- Legal name
- JOHN FITZGIBBON MEMORIAL HOSPITAL INC
- Doing business as
- FITZGIBBON HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jul 13, 2023
- Beds
- 60
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 2305 S Highway 65
Marshall, MO 65340-3702 - Hospital subgroups
- Acute care, Swing-bed approved, Psychiatric unit
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| John Fitzgibbon Memorial Hospital Inc |
5% Or Greater Direct Ownership Interest | Jul 1, 1966 | 100% |
| Operational/Managerial Control | Jul 1, 1966 | ||
| Jan Stapleton |
Other | Sep 22, 2015 | |
| Scott Hartwig |
Other |
Sep 22, 2015 | |
| Darin L Haug |
W-2 Managing Employee |
Sep 1, 2012 | |
| William L Summers |
Other |
Jan 1, 1999 | |
| Mary Lou Porter |
Other | Oct 25, 2016 | |
| Nancy K Harris |
Corporate Officer |
Feb 14, 2020 | |
| W-2 Managing Employee | Feb 14, 2020 | ||
| Angela P Littrell |
Corporate Officer |
Feb 14, 2020 | |
| W-2 Managing Employee | Jun 2, 2014 | ||
| Jared K Romney |
Other |
May 1, 2023 | |
| Angela Igo |
W-2 Managing Employee |
Jan 1, 2016 | |
| Thomas Jones |
W-2 Managing Employee |
Feb 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040315000980 | MO | Part B Supplier - Clinic/Group Practice | 2567351570 |
Receives reassigned benefits from 68 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marshall, MO; Pilot Grove, MO |
| O20080104000462 | MO | Part a Provider - Hospital | 2567351570 |
11 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brunswick, MO; Fayette, MO; Marshall, MO; Pilot Grove, MO; Slater, MO |
National Provider Directory
- Part of
- Marshall Surgical Assoc
Locations
815 E Broadway St
Brunswick, MO 65236
Phone (660) 548-3161
2305 S Highway 65
Marshall, MO 65340
Phone (660) 831-3730
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 598917607 | MO | Yes |
Addresses
Primary practice location
815 E. Broadway Street
Brunswick, MO 65236-1468
Mailing address
2305 South 65 Highway
Marshall, MO 65340-3702
Phone (660) 548-3161
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 508292604 | Medicaid | MO | |
| 598917607 | Medicaid | MO |
Other names
- Grand River Medical Center
Other providers in Brunswick, MO
- Brunswick SNF Opco LLC
- Joanie M Defibaugh
- Jessica L Elliott
- Danielle Elizabeth Hamilton
- Jefferson Medical Group
- Jukeco Enterprises LLC
- Margaret J Larson
- Lightning Creek Investment Group,Inc
- Trent Link
- Nancy J Lock
All providers in Brunswick, 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 Mar 5, 2024. 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.