NPIMap

Organization Active NPI

Southeast Hospital

Doing business as Mercy Hospice

  • Community Based Hospice Care Agency
  • Cape Girardeau, MO
National Provider Identifier
1982788196
Registry record updated Jan 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
037-9HO Issued in MO
Legal business name
SOUTHEAST HOSPITAL
Doing business as
Mercy Hospice
Practice address
1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone
(573) 335-6208
Fax
(573) 334-8754
NPI assigned
Oct 24, 2006
Last updated
Jan 13, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2024

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

Authorized official

Name
Krista Berry
Title
Cfo
Phone
(573) 331-6028

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 037-9HO MO Primary

Addresses

Primary practice location

1701 Lacey St
Cape Girardeau, MO 63701-5230

Mailing address

1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 335-6208

Other names 1

  • MERCY HOSPICE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050516000753 MO Part A Provider - Hospice 7719897776 Practice locations: Cape Girardeau, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982788196. Details of each certification follow.

Hospice certification: CCN 261537

Legal name
SOUTHEAST HOSPITAL
Doing business as
MERCY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 21, 1993
Last certification
Mar 28, 2019
Ownership / control type
Other
Organization structure
CorporationNon-profit
Enrollment address
1701 Lacey St
Cape Girardeau, MO 63701-5230

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Mercy HospiceCCN 261537 · All quality measures
Ownership
For-Profit
Certified
Jul 21, 1993
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Southeast Mo Hospital4 organizations share this tax ID, including this one
Part of
Southeast Mo Hospital

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Andrew J Moore Individual Corporate DirectorBoard Member Jan 1, 2024
Carl E Ammons Individual Corporate OfficerRegional President Jan 1, 2024
Stanley L Crader Individual Corporate OfficerTreasurer Jan 1, 2024
Steven M Green Individual Other Jan 1, 2017
Christopher Wibbenmeyer Individual Corporate DirectorBoard Member Jan 1, 2024
Charles Kruse Individual Corporate OfficerSecretary Jan 1, 2024
Angie Umfleet Individual Corporate DirectorChair Jan 1, 2024
Krista Berry Individual Corporate DirectorCfo Jan 15, 2024
W-2 Managing Employee Oct 1, 2015
Michael Kohlfeld Individual Other Jan 1, 2013
Frank M Kinder Individual Other Oct 1, 2015
Andrew Runge Individual Corporate DirectorBoard Member Jan 1, 2024
Andrea Marchi Individual W-2 Managing EmployeeAd; Jan 1, 2025
Stacie Farnam Individual W-2 Managing EmployeeDirector Dec 20, 2023
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Dec 20, 2023 100%
Benjamin F Lewis Individual Other Jan 1, 2017
Curt Buchheit Individual Corporate DirectorVice Chair Jan 1, 2024
Naresh Agarwal Individual Corporate DirectorBoard Member Jan 1, 2024
Southeasthealth System Inc Organization, Cape Girardeau, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 30, 2013 100%
Wade a Richey Individual Corporate DirectorBoard Member Jan 1, 2024
Fred Ducharme Individual Other Jan 1, 2022
Mercy Health East Communities Organization, Saint Louis, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 20, 2023 100%
James J Dufek Individual Other Jan 1, 2013

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Mercy Hospital StoddardDexter, MO, CCN 260160 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardDexter, MO, CCN 26U160 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Southeast Behavioral HospitalCape Girardeau, MO, CCN 264034 Hospital 5% Or Greater Direct Ownership Interest (25%) Aug 5, 2020
Mercy Southeast Primary Care WestCape Girardeau, MO, CCN 268657 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2001
Mercy Southeast PediatricsCape Girardeau, MO, CCN 268674 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2006
Mercy Hospital StoddardDexter, MO, CCN 268658 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardDexter, MO, CCN 268570 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardMalden, MO, CCN 268661 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardBloomfield, MO, CCN 268587 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardBernie, MO, CCN 268683 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardSikeston, MO, CCN 268768 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2013
Mercy Hospital StoddardNew Madrid, MO, CCN 268777 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%) Jul 2, 2019

Owned or controlled facilities with NPI records 12

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

Facilities with the same owner 116

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

View all 116

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": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705104000000",
    "number": "1982788196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-335-6208",
            "fax_number": "573-334-8754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 LACEY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637015230",
            "telephone_number": "573-335-6208",
            "fax_number": "573-334-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST HOSPITAL",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-331-6028"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "037-9HO",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.