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Organization Active NPI

General John J Pershing Memorial Hospital Association

Doing business as Pershing Memorial Hospital

  • Primary Care Clinic/Center
  • Brookfield, MO
National Provider Identifier
1982612461
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Pershing Memorial Hospital
Practice address
130 E Lockling Ave
Brookfield, MO 64628-0408
Phone
(660) 258-2222
Fax
(660) 258-5668
NPI assigned
Aug 3, 2006
Last updated
Nov 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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

Authorized official

Name
Mr. Kenneth E Baranski, CPA
Title
Cfo
Phone
(660) 258-1288

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary
Personal Emergency Response Attendant 146D00000X 19843 MO

Addresses

Primary practice location

130 E Lockling Ave
Brookfield, MO 64628-0408

Mailing address

130 E Lockling Ave
P.O. Box 408
Brookfield, MO 64628-0408
Phone (660) 258-2222

Other identifiers 2

IdentifierTypeStateIssuer
912858305MedicaidMO
540570405MedicaidMO

Other names 1

  • Pershing Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000114 MO Part B Supplier - Clinic/Group Practice 2860306750 Receives reassigned benefits from 86 practitioners
Practice locations: Brookfield, MO

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Pershing Hosp Home HLTH8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Meadville Medical ClinicMeadville, MO, CCN 268682 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2012
Jul 10, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 92

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.

View all 92

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1982612461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E LOCKLING AVE",
            "address_2": "P.O. BOX 408",
            "city": "BROOKFIELD",
            "state": "MO",
            "postal_code": "646280408",
            "telephone_number": "660-258-2222",
            "fax_number": "660-258-5668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E LOCKLING AVE",
            "city": "BROOKFIELD",
            "state": "MO",
            "postal_code": "646280408",
            "telephone_number": "660-258-2222",
            "fax_number": "660-258-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "BARANSKI",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-258-1288",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "MO",
            "license": "19843",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912858305",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540570405",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pershing Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pershing Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, MO

Sources for this page

Verify at the official NPI Registry.