NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center LLC

Doing business as Poplar Bluff Regional Medical Center

  • Rehabilitation Hospital Unit
  • Poplar Bluff, MO
National Provider Identifier
1962446054
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
Poplar Bluff Regional Medical Center
Practice address
2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone
(573) 785-7721
Fax
(573) 776-9086
NPI assigned
Jun 16, 2006
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
POPLAR BLUFF REGIONAL MEDICAL CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

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

Authorized official

Name
Paula Lalor
Title
Director/Delegated Official
Phone
(629) 215-3953

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary
General Acute Care Hospital 282N00000X NU

Addresses

Primary practice location

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396

Mailing address

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 785-7721

Other identifiers 1

IdentifierTypeStateIssuer
011602505MedicaidMO

Other names 1

  • Poplar Bluff Regional Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070710000096 MO Part A Provider - Hospital 6800707225 Practice locations: Poplar Bluff, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962446054. Details of each certification follow.

Hospital certification: CCN 26T119

Legal name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
POPLAR BLUFF REGIONAL MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Apr 14, 2009 in MO
Enrollment address
2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation

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

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Poplar Bluff Regional Med CtrCCN 26T119 · All quality measures
Ownership
For profit
Certified
Jan 1, 1993

National Provider Directory

National Provider Directory
Tax ID family
Malden Medical Center11 organizations share this tax ID, including this one
Part of
Malden Medical Center

Other organizations with this tax ID 10

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

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

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
Kevin J Hammons Individual Corporate OfficerPresident /Board Member Jan 27, 2014
Corporate DirectorPresident/Board Member Jan 1, 2020
Nathaniel K Summar Individual OtherVP Revenue Management Jul 15, 2017
Justin D Pitt Individual Corporate OfficerExec VP/Assist Sec/Board Member Mar 1, 2022
Corporate DirectorExec VP/Assist Sec/Board Member Mar 1, 2022
Health Management Associates LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 99%
William Bradley Cash Individual Corporate OfficerExec VP Jun 1, 2018
Hma-Tri Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Indirect Ownership Interest Dec 31, 2015 100%
Community Health Systems Inc Organization, Franklin, TN Corporation 5% Or Greater Indirect Ownership Interest Jan 27, 2014 100%
Jason Kevin Johnson Individual Corporate OfficerSenior VP Jan 6, 2020
Central States Hma Holdings LLC Organization, Franklin, TN LLC 5% Or Greater Direct Ownership Interest Jan 27, 2014 100%
Bryan Clyde Wood Individual W-2 Managing EmployeeCeo Apr 21, 2025
Roman Gabriel Ottinger Individual Corporate OfficerSenior VP/Treasurer Jan 6, 2020
Health Management Associates LP Organization, Franklin, TN 5% Or Greater Indirect Ownership Interest Jan 27, 2014 99%
Paula M Lalor Individual Corporate DirectorDirector PFS Apr 1, 2017
Edna S Buffington-Price Individual Corporate DirectorVP/Authorized Official Mar 1, 2022
Christopher G Cobb Individual Corporate OfficerVP/Secretary Jan 27, 2014
CHS Community Health Systems Inc Organization, Franklin, TN Corporation, Chain home office 5% Or Greater Indirect Ownership Interest Jan 27, 2014 100%

Facilities with the same owner 120

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

  • Kirksville Missouri Hospital Company LLC

    dba Northeast Regional Medical Group

    • Rural Health Clinic/Center
    • Kirksville, MO
    • NPI 1508135005

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • General Acute Care Hospital
    • Kirksville, MO
    • NPI 1104899442

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Kirksville Missouri Hospital Company, LLC

    dba Northeast Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Kirksville, MO
    • NPI 1932172293

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Moberly, MO
    • NPI 1346212784

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • Psychiatric Hospital Unit
    • Moberly, MO
    • NPI 1366413882

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Rural Health Clinic

    • Rural Health Clinic/Center
    • Moberly, MO
    • NPI 1407989510

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Moberly Regional Medical Center

    • General Acute Care Hospital
    • Moberly, MO
    • NPI 1770554305

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Moberly Hospital Company LLC

    dba Chariton Valley Family Medicine

    • Rural Health Clinic/Center
    • Salisbury, MO
    • NPI 1851713580

    CHS Community Health Systems Inc, Community Health Systems Inc

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Puxico Medical Clinic

    • Rural Health Clinic/Center
    • Puxico, MO
    • NPI 1275576654

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Dexter Medical Center

    • Rural Health Clinic/Center
    • Dexter, MO
    • NPI 1700821212

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Poplar Bluff Regional Medical Center

    • General Acute Care Hospital
    • Poplar Bluff, MO
    • NPI 1700831724

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
  • Poplar Bluff Regional Medical Center LLC

    dba Malden Medical Center

    • Rural Health Clinic/Center
    • Malden, MO
    • NPI 1801839147

    Central States Hma Holdings LLC, CHS Community Health Systems Inc, Community Health Systems Inc, Health Management Associates LLC, Health Management Associates LP, Hma-Tri Holdings LLC

    CMS ownership
View all 120

Practitioners & affiliated clinicians

Practitioners 1

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 4

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": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1962446054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639011573",
            "telephone_number": "573-785-7721",
            "fax_number": "573-776-9086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013396",
            "telephone_number": "573-785-7721",
            "fax_number": "573-776-9086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER LLC",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "629-215-3953"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011602505",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Bluff Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.