NPIMap

Organization Active NPI

Clinton No 1 Inc

  • Skilled Nursing Facility
  • Clinton, MO
National Provider Identifier
1033141015
Registry record updated Mar 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
046098 Issued in MO
Legal business name
CLINTON NO 1 INC
Practice address
1009 E Ohio St
Clinton, MO 64735-2455
Phone
(660) 885-5571
NPI assigned
Jul 7, 2006
Last updated
Mar 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2018

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

Authorized official

Name
Mr. Donald B Bedell
Title
President
Phone
(573) 471-1276

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 046098 MO Primary

Addresses

Primary practice location

1009 E Ohio St
Clinton, MO 64735-2455

Mailing address

PO Box 1210
Sikeston, MO 63801-1210

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610001472 MO Part A Provider - Skilled Nursing Facility 1658354592 Practice locations: Clinton, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033141015. Details of each certification follow.

Skilled nursing facility certification: CCN 265255

Legal name
CLINTON NO 1 INC
Doing business as
CLINTON HEALTHCARE AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 11, 1984
Last certification
Sep 5, 2024
Beds
120
Ownership / control type
Corporation
Multi-facility organization
ADVANT GUARDE
Most recent change of ownership
May 5, 2004
Organization structure
CorporationProprietary
Enrollment address
1009 E Ohio St
Clinton, MO 64735-2455
Nursing home name
CLINTON HEALTHCARE AND REHABILITATION CENTER
Affiliated entity
CIRCLE B ENTERPRISES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Clinton Healthcare and Rehabilitation CenterCCN 265255 · All quality measures
Overall star rating
1 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 11, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12070.0 residents per day on average
Chain
Circle B Enterprises36 facilities in the chain
Penalties (3 years)
2Fines totaling $83,041

Processed by Care Compare on Aug 1, 2026.

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
26D0721193Clinton Healthcare & Rehabilitation Center1009 E Ohio Street, Clinton, MO 64735Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Sovereign Healthcare Group LLC Organization, Sikeston, MO LLC, Medical provider/supplier Operational/Managerial Control Apr 23, 2021
Adp of the SNF Apr 6, 2025
FG LLC Organization, Sikeston, MO LLC Adp of the SNF Dec 2, 2016
Mid States Inc Organization, Sikeston, MO Corporation, Management services company Adp of the SNF Aug 15, 2014
Individual Adp of the SNF Jan 1, 2000
Van de Ven LLC Organization, Cape Girardeau, MO LLC Adp of the SNF Jan 1, 2000
Todd Beaird Individual Corporate OfficerSecretary Jan 1, 2022
Adp of the SNF Jan 1, 2022
Georgann Foster Individual Operational/Managerial Control Dec 29, 2025
Adp of the SNF Dec 29, 2025
Donald B Bedell Individual Corporate OfficerPresident Apr 23, 2004 100%
Corporate DirectorPresident Apr 23, 2004
Operational/Managerial Control Apr 23, 2004
DCB Real Estate Partnership LP Organization, Sikeston, MO Adp of the SNF Mar 12, 2013
Clinton Exempt Trust Organization, Sikeston, MO 5% Or Greater Direct Ownership Interest Apr 23, 2004 100%
Trustee of the SNF Apr 23, 2004
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Adp of the SNF Aug 16, 2021
Agh1 LLC Organization, Sikeston, MO LLC, Management services company, Consulting firm Operational/Managerial Control Dec 2, 2016
Adp of the SNF Mar 25, 2025
Mark P Snell Individual Operational/Managerial Control Sep 1, 2001
Adp of the SNF Sep 1, 2001
Clinton Re LLC Organization, Sikeston, MO LLC Adp of the SNF Mar 12, 2013
Individual Adp of the SNF Jan 1, 2000

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 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 5

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": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520208000000",
    "number": "1033141015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638011210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 E OHIO ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647352455",
            "telephone_number": "660-885-5571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON NO 1 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2018-03-05",
        "status": "A",
        "authorized_official_last_name": "BEDELL",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-471-1276",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "046098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

Verify at the official NPI Registry.