NPIMap

Organization Active NPI

Mercy Hospital Booneville

  • Critical Access Hospital
  • Booneville, AR
National Provider Identifier
1992133714
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
MERCY HOSPITAL BOONEVILLE
Practice address
880 W Main St
Booneville, AR 72927-3443
Phone
(479) 675-2800
NPI assigned
Oct 15, 2013
Last updated
Sep 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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
Phone
(417) 820-8439

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary
Surgery Physician 208600000X

Addresses

Primary practice location

880 W Main St
Booneville, AR 72927-3443

Mailing address

880 W Main St
Booneville, AR 72927-3443
Phone (479) 675-2800

Other identifiers 2

IdentifierTypeStateIssuer
204253105MedicaidAR
200700880AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140312001275 AR Part A Provider - Critical Access Hospital 1951530385 Receives reassigned benefits from 112 practitioners
Practice locations: Booneville, AR
O20170203001490 AR Part B Supplier - Clinic/Group Practice 1951530385 Receives reassigned benefits from 142 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Magazine, AR; Booneville, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992133714. Details of each certification follow.

Hospital certification: CCN 041318

Legal name
MERCY HOSPITAL BOONEVILLE
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 2, 2003
Last certification
Nov 5, 2020
Beds
25
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jan 1, 2014 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Oct 10, 2013 in AR
Enrollment address
880 W Main St
Booneville, AR 72927-3443

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Hospital BoonevilleCCN 041318 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mercy Hospital Booneville4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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 Fort Smith Communities Organization, Ft Smith, AR Corporation, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%
Ryan Gehrig Individual Corporate OfficerPresident Jan 1, 2014
W-2 Managing EmployeePresident Jan 1, 2014
Elizabeth Maddox Individual Corporate DirectorBoard Member Jul 1, 2024 1%
Yogya Regmi Individual W-2 Managing EmployeeDirector Aug 29, 2022
Michael Keith Gibbons Individual Corporate DirectorBoard Member Jul 1, 2022
Edward Melton Individual Corporate DirectorBoard Member Jul 1, 2024
Bret Cook Individual Corporate DirectorBoard Member Jul 1, 2022
Mercy Hospital Fort Smith Organization, Fort Smith, AR Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Martha Ullrich Individual Corporate DirectorBoard Member Jul 1, 2021
Allen Ray Individual Corporate DirectorBoard Member Jul 1, 2024
Mercy Health Organization, Chesterfield, MO Corporation, Non-profit, Chain home office Operational/Managerial Control Jan 2, 2014 100%
Carol Corley Individual Corporate DirectorBoard Member Jul 1, 2021
Judith Marie Keith Individual Corporate DirectorBoard Member Jul 1, 2021
Sherry Clouse Day Individual Corporate OfficerTreasurer Jan 1, 2021
W-2 Managing EmployeeVP Finance Jan 1, 2021
Vicky Laird Individual Corporate DirectorBoard Member Jul 1, 2021

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 115

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

View all 115

Practitioners & affiliated clinicians

Practitioners 155

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 155

Affiliated clinicians 97

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1992133714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "880 W MAIN ST",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729273443",
            "telephone_number": "479-675-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 W MAIN ST",
            "city": "BOONEVILLE",
            "state": "AR",
            "postal_code": "729273443",
            "telephone_number": "479-675-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HOSPITAL BOONEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "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",
        "authorized_official_telephone_number": "417-820-8439"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204253105",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200700880A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, AR

Sources for this page

Verify at the official NPI Registry.