NPIMap

Organization Active NPI

Thayer No 1 Inc

  • Skilled Nursing Facility
  • Thayer, MO
National Provider Identifier
1972535920
Registry record updated Mar 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
046004 Issued in MO
Legal business name
THAYER NO 1 INC
Practice address
335 Business Route 63
Thayer, MO 65791
Phone
(417) 264-7256
NPI assigned
Jul 7, 2006
Last updated
Mar 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2020

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

Authorized official

Name
Mr. Donald B Bedell
Title
President
Phone
(573) 471-1276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 046004 MO Primary

Addresses

Primary practice location

335 Business Route 63
Thayer, MO 65791

Mailing address

PO Box 1210
Sikeston, MO 63801-1210

Other identifiers 1

IdentifierTypeStateIssuer
101483303MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040611000420 MO Part A Provider - Skilled Nursing Facility 5193708949 Practice locations: Thayer, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972535920. Details of each certification follow.

Skilled nursing facility certification: CCN 265246

Legal name
THAYER NO 1 INC
Doing business as
SHADY OAKS HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 21, 1984
Last certification
Aug 1, 2024
Beds
120
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Enrollment address
335 Business Route 63
Thayer, MO 65791-7748
Nursing home name
SHADY OAKS HEALTHCARE CENTER
Affiliated entity
CIRCLE B ENTERPRISES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shady Oaks Healthcare CenterCCN 265246 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 21, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12072.3 residents per day on average
Chain
Circle B Enterprises36 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0447527Shady Oaks Healthcare Center335 Business Route 63, Thayer, MO 65791Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
The Thayer Exempt Trust Dated 04/23/2004 Organization, Sikeston, MO 5% Or Greater Direct Ownership Interest Apr 23, 2004 100%
Sovereign Healthcare Group LLC Organization, Sikeston, MO LLC, Medical provider/supplier Operational/Managerial Control Apr 23, 2021
Adp of the SNF Apr 6, 2025
Thayer Re LLC Organization, Sikeston, MO LLC Adp of the SNF Mar 12, 2013
FG LLC Organization, Sikeston, MO LLC Adp of the SNF Mar 24, 2020
Mid States Inc Organization, Sikeston, MO Corporation, Management services company Adp of the SNF Mar 24, 2020
Van de Ven LLC Organization, Cape Girardeau, MO LLC Adp of the SNF Mar 24, 2020
Todd Beaird Individual Corporate OfficerCorporate Secretary Jan 1, 2022
Adp of the SNF Jan 1, 2022
Donald B Bedell Individual Corporate OfficerPresident Apr 23, 2004 100%
Corporate DirectorPresident Jun 11, 2004
Operational/Managerial Control Apr 23, 2004
Individual Adp of the SNF Jan 1, 2000
Christopher Cochran Individual Operational/Managerial Control Jan 1, 2005
Adp of the SNF Jan 1, 2005
Tiffani Allen Individual Operational/Managerial Control Jan 28, 2025
Adp of the SNF Jan 28, 2025
DCB Real Estate Partnership LP Organization, Sikeston, MO Adp of the SNF Mar 12, 2013
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Adp of the SNF Aug 16, 2021
Agh1 LLC Organization, Sikeston, MO LLC, Management services company, Consulting firm Operational/Managerial Control Mar 24, 2020
Adp of the SNF Jul 11, 2025
Individual Adp of the SNF Jan 1, 2000

Owners & managing parties with NPI records 2

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

Facilities with the same owner 36

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

View all 36

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 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": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585612800000",
    "number": "1972535920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638011210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 BUSINESS ROUTE 63",
            "city": "THAYER",
            "state": "MO",
            "postal_code": "65791",
            "telephone_number": "417-264-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THAYER NO 1 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2020-03-31",
        "certification_date": "2020-03-31",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-471-1276",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "046004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101483303",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thayer, MO

Sources for this page

Verify at the official NPI Registry.