NPIMap

Organization Active NPI

Mercy Hospital Carthage

  • Rural Health Clinic/Center
  • Carthage, MO
National Provider Identifier
1992074959
Registry record updated Apr 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HOSPITAL CARTHAGE
Practice address
3114 Medical Park Dr
Carthage, MO 64836-1211
Phone
(417) 358-0188
Fax
(417) 358-4612
NPI assigned
Dec 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2024

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

Authorized official

Name
Sherry Lynn Clouse Day
Title
VP Finance Mercy Cah
Phone
(417) 820-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

3114 Medical Park Dr
Carthage, MO 64836-1211

Mailing address

3114 Medical Park Dr
Carthage, MO 64836-1211
Phone (417) 358-0188

Other names 1

  • MERCY HOSPITAL CARTHAGE - WOMEN'S HEALTH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120225000071 MO Part B Supplier - Clinic/Group Practice 8426225251 Receives reassigned benefits from 134 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carthage, MO
O20121009000229 MO Part A Provider - Rural Health Clinic 8426225251 Practice locations: Carthage, MO

Rural health clinic certification: CCN 268688

Legal name
MERCY HOSPITAL CARTHAGE
Doing business as
MERCY HOSPITAL CARTHAGE-WOMEN'S HEALTH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 11, 2013
Last certification
Jan 27, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
3114 Medical Park Dr
Carthage, MO 64836-1211
Related CCNs
261338

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Carthage7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Member organizations 4

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

Locations

1515 Hazel Ave
Ste 101
Carthage, MO 64836
Phone (417) 358-0188

1615 Hazel Ave
Ste 101
Carthage, MO 64836

3114 Medical Park Dr
Carthage, MO 64836
Phone (417) 358-0188

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jamie Wilke Individual Corporate OfficerSecretary Jul 1, 2024
Mercy Health Southwest Missouri Kansas Communities Organization, Joplin, MO Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 2, 2012 100%
Shannon Sock Individual Corporate Director Jul 1, 2021
John M Mohart Individual Corporate Director Jul 1, 2021
Jeremy S Drinkwitz Individual Corporate OfficerPresident Sep 1, 2025
Jeffrey Peter Ciaramita Individual Corporate Director Jul 1, 2021
Belinda Farmer Individual Corporate DirectorBoard Member Sep 1, 2025
Stacie Farnam Individual W-2 Managing Employee Jan 1, 2021
Mercy Health Organization, St Louis, MO Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Aug 1, 2012 100%
Sherry Clouse Day Individual Corporate OfficerTreasurer Aug 14, 2020
Brian Day Individual Corporate OfficerSenior Vice President Sep 1, 2025

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 114

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

View all 114

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1992074959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3114 MEDICAL PARK DR",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648361211",
            "telephone_number": "417-358-0188",
            "fax_number": "417-358-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3114 MEDICAL PARK DR",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648361211",
            "telephone_number": "417-358-0188",
            "fax_number": "417-358-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL CARTHAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "CLOUSE DAY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "VP FINANCE MERCY CAH",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HOSPITAL CARTHAGE - WOMEN'S HEALTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carthage, MO

Sources for this page

Verify at the official NPI Registry.