NPIMap

Organization Active NPI

Prime Healthcare Services Blue Springs, LLC

Doing business as St. Mary's Hospital

  • Rehabilitation Hospital Unit
  • Blue Springs, MO
National Provider Identifier
1962809947
Registry record updated Nov 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
403-20 Issued in MO
Legal business name
PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLC
Doing business as
St. Mary's Hospital
Practice address
201 NW R D Mize Rd
Blue Springs, MO 64014-2513
Phone
(816) 228-5900
NPI assigned
Nov 19, 2014
Last updated
Nov 19, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2014

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

Authorized official

Name
Prem Reddy, M.D.
Title
Chairman/President
Phone
(909) 235-4400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 403-20 MO Primary

Addresses

Primary practice location

201 NW R D Mize Rd
Blue Springs, MO 64014-2513

Mailing address

201 NW R D Mize Rd
Blue Springs, MO 64014-2513
Phone (816) 228-5900

Other identifiers 2

IdentifierTypeStateIssuer
11444403MedicaidMO
431284526OtherTRICARE

Other names 1

  • St. Mary's Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150616002781 MO Part A Provider - Hospital 7113241118 Practice locations: Blue Springs, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962809947. Details of each certification follow.

Hospital certification: CCN 26T193

Legal name
PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLC
Doing business as
ST. MARY'S MEDICAL CENTER
Organization structure
LLCProprietary
Enrollment address
201 NW Rd Mize Rd
Blue Springs, MO 64014-2513
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
St Marys Medical CenterCCN 26T193 · All quality measures
Ownership
For profit
Certified
Jul 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services Blue Springs LLC4 organizations share this tax ID, including this one
Part of
Prime Healthcare Services Blue Springs LLC

Other organizations with this tax ID 3

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

Member organizations 1

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

Locations

3300 E Guasti Rd
Fl 2
Ontario, CA 91761

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA For-profit 5% Or Greater Direct Ownership Interest Feb 13, 2015 100%
Kelly Pearce Individual W-2 Managing EmployeeAd;Chief Executive Officer Feb 28, 2022
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 1, 2013
Kenneth Wheeler Individual Corporate OfficerVP of Patient Financial Services Dec 13, 2015
W-2 Managing EmployeeVP of Patient Financial Services Feb 13, 2015
Prime Healthcare Holdings Inc Organization, Ontario, CA For-profit 5% Or Greater Indirect Ownership Interest Feb 13, 2015 100%

Facilities with the same owner 77

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

View all 77

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

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": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1962809947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 NW R D MIZE RD",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142513",
            "telephone_number": "816-228-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 NW R D MIZE RD",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142513",
            "telephone_number": "816-228-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME HEALTHCARE SERVICES BLUE SPRINGS, LLC",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "REDDY",
        "authorized_official_first_name": "PREM",
        "authorized_official_title_or_position": "CHAIRMAN/PRESIDENT",
        "authorized_official_telephone_number": "909-235-4400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MO",
            "license": "403-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11444403",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "431284526",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blue Springs, MO

Sources for this page

Verify at the official NPI Registry.