NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital, Inc.

Doing business as Grand River Medical Center

  • Rural Health Clinic/Center
  • Brunswick, MO
National Provider Identifier
1922032549
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
598917607 Issued in MO
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.
Doing business as
Grand River Medical Center
Practice address
815 E. Broadway Street
Brunswick, MO 65236-1468
Phone
(660) 886-7431
Fax
(660) 831-3328
NPI assigned
Jul 10, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 598917607 MO Primary

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 2

IdentifierTypeStateIssuer
508292604MedicaidMO
598917607MedicaidMO

Other names 1

  • Grand River Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1922032549. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
2305 S Highway 65
Marshall, MO 65340-3702
Other Hospital Practice Location
Hospital subgroups
Acute care, Swing-bed approved, Psychiatric unit

Rural health clinic certification: CCN 263498

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
GRAND RIVER MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 9, 1996
Last certification
Sep 26, 2023
Ownership / control type
2A
Facility address
815 East Broadway
Brunswick, MO 65236
Related CCNs
260142

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

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

Care Compare: Hospital

Medicare Care Compare
Listed as
Fitzgibbon HospitalCCN 260142 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Grandriver Medical Clin

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Fitzgibbon Memorial Hospital Inc Organization, Marshall, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1966 100%
Operational/Managerial Control Jul 1, 1966
Jan Stapleton Individual Other Sep 22, 2015
Scott Hartwig Individual OtherSecretary Sep 22, 2015
Darin L Haug Individual W-2 Managing EmployeeCmo Sep 1, 2012
William L Summers Individual OtherPresident Jan 1, 1999
Mary Lou Porter Individual Other Oct 25, 2016
Nancy K Harris Individual Corporate OfficerCfo Feb 14, 2020
W-2 Managing Employee Feb 14, 2020
Angela P Littrell Individual Corporate OfficerPresident & Ceo Feb 14, 2020
W-2 Managing Employee Jun 2, 2014
Jared K Romney Individual OtherPresident of Medical Staff May 1, 2023
Angela Igo Individual W-2 Managing EmployeeCno Jan 1, 2016
Thomas Jones Individual W-2 Managing EmployeeCio Feb 1, 2011

Owners & managing parties with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 130

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

View all 130

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1922032549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 SOUTH 65 HIGHWAY",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-548-3161",
            "fax_number": "660-584-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 E. BROADWAY STREET",
            "city": "BRUNSWICK",
            "state": "MO",
            "postal_code": "652361468",
            "telephone_number": "660-886-7431",
            "fax_number": "660-831-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2006-07-10",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7431"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "598917607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508292604",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598917607",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand River Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brunswick, MO

Sources for this page

Verify at the official NPI Registry.