NPIMap

Organization Active NPI

Midwest Division - LRHC LLC

Doing business as Odessa Medical Group

  • Rural Health Clinic/Center
  • Odessa, MO
National Provider Identifier
1003872185
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MIDWEST DIVISION - LRHC LLC
Doing business as
Odessa Medical Group
Practice address
316 West 40 Hwy
Odessa, MO 64076-9612
Phone
(816) 633-5774
Fax
(816) 633-5936
NPI assigned
Apr 26, 2006
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MIDWEST DIVISION - LRHC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Darrel Box
Title
Ceo LRHC
Phone
(660) 259-6852

Specialties & licenses 1

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

Addresses

Primary practice location

316 West 40 Hwy
Odessa, MO 64076-9612

Mailing address

316 West 40 Hwy
Odessa, MO 64076-9612
Phone (816) 633-5774

Other identifiers 3

IdentifierTypeStateIssuer
540568508MedicaidMO
595985805MedicaidMO
010568509MedicaidMO

Other names 1

  • ODESSA MEDICAL GROUP Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address LAFAYETTE.COCLAF.KSA@CCDA.HCADIRECT.NET

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070912000596 MO Part A Provider - Rural Health Clinic 0941119150 Practice locations: Odessa, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003872185. Details of each certification follow.

Rural health clinic certification: CCN 268550

Legal name
MIDWEST DIVISION - LRHC LLC
Doing business as
ODESSA MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 27, 2002
Last certification
May 29, 2019
Ownership / control type
1B
Most recent change of ownership
Apr 1, 2003 (1 total)
Organization structure
LLCProprietary
Enrollment address
316 W US Highway 40
Odessa, MO 64076-7445
Related CCNs
261320

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

Other NPIs with the same Medicare PAC ID 5

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

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
26D0908581Odessa Medical Group316 West 40 Hwy, Odessa, MO 64076Provider-performed microscopyNov 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Midwest Division - LRHC LLC9 organizations share this tax ID, including this one
Part of
Midwest Division - LRHC LLC

Other organizations with this tax ID 8

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

Networks

  • devoted network organization-4d06b5ed-aefa-4033-b81c-2adf126fd114

Interoperability endpoints

  • Direct secure messaging: lafayette.coclaf.ksa@ccda.hcadirect.net

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
HCA Inc Organization, Nashville, TN For-profit 5% Or Greater Indirect Ownership Interest Jul 6, 2011 100%
Teri R James Individual Corporate OfficerCfo Feb 1, 2008
W-2 Managing EmployeeCfo Feb 1, 2008
Eric D Smith Individual Contracted Managing EmployeeVice President of Reimbursement Mar 1, 2021
HCA Healthcare Inc Organization, Nashville, TN Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest May 8, 2017 100%
Frisco Holding II Organization, Wilmington, DE Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Feb 6, 2026 16%
Hercules Holding II Organization, Nashville, TN Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Sep 30, 2016 14%
Healthtrust Inc - the Hospital Company Organization, Nashville, TN For-profit 5% Or Greater Indirect Ownership Interest Jul 6, 2011 100%
Darrel Box Individual Corporate OfficerCeo Jan 28, 2013
W-2 Managing EmployeeCeo Jan 8, 2013
Midwest Holdings, Inc. Organization, Nashville, TN For-profit 5% Or Greater Direct Ownership Interest Jul 6, 2011 100%

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1003872185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 WEST 40 HWY",
            "city": "ODESSA",
            "state": "MO",
            "postal_code": "640769612",
            "telephone_number": "816-633-5774",
            "fax_number": "816-633-5936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 WEST 40 HWY",
            "city": "ODESSA",
            "state": "MO",
            "postal_code": "640769612",
            "telephone_number": "816-633-5774",
            "fax_number": "816-633-5936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST DIVISION - LRHC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST DIVISION - LRHC LLC",
        "enumeration_date": "2006-04-26",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "BOX",
        "authorized_official_first_name": "DARREL",
        "authorized_official_title_or_position": "CEO LRHC",
        "authorized_official_telephone_number": "660-259-6852"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540568508",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "595985805",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010568509",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "LAFAYETTE.COCLAF.KSA@CCDA.HCADIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "Please contact CORP.HCACEP@HCAHealthcare.com for information regarding validation steps that may be required to ensure CCDs sent to the listed direct address are successfully received.",
            "address_1": "1500 State St",
            "city": "Lexington",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640671107",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ODESSA MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ODESSA MEDICAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Odessa, MO

Sources for this page

Verify at the official NPI Registry.