NPIMap

Organization Active NPI

Cross Trails Medical Center

  • Federally Qualified Health Center (FQHC)
  • Cape Girardeau, MO
National Provider Identifier
1033895628
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CROSS TRAILS MEDICAL CENTER
Practice address
2430 Golden Street
Cape Girardeau, MO 63703
Phone
(573) 339-1196
Fax
(573) 339-9378
NPI assigned
Jun 27, 2023
Organization subpart
Yes
Parent organization
CROSS TRAILS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Authorized official

Name
Sheila Pruitt
Title
Billing Coordinator
Phone
(573) 332-0808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2430 Golden Street
Cape Girardeau, MO 63703

Mailing address

408 S Broadview St
Cape Girardeau, MO 63703-5725
Phone (573) 332-0808

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000205 MO Part B Supplier - Clinic/Group Practice 8820902851 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Perryville, MO; Marble Hill, MO; Cape Girardeau, MO; Advance, MO
O20230725003377 MO Part A Provider - Federally Qualified Health Center (FQHC) 8820902851 Practice locations: Cape Girardeau, MO

Federally qualified health center certification: CCN 261936

Legal name
CROSS TRAILS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2023
Last certification
Jul 12, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1994 in MO
Enrollment address
2430 Golden St
Cape Girardeau, MO 63703-5770

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 4

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

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
26D2082659Cross Trails Medical Center2430 Golden Street, Cape Girardeau, MO 63703ComplianceDec 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Cross Trails Medical Ce9 organizations share this tax ID, including this one
Part of
Cross Trails Medical Ce

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Rebecca Garris Individual Corporate DirectorBoard Member Mar 1, 2024
Chrissy Warren Individual Corporate OfficerCoo Jul 28, 2010
Fran Seabaugh Individual Corporate DirectorBoard Member Jan 1, 1995
Amy Lanzotti Individual Corporate OfficerCfo Jun 29, 2024
Kathy Hotop-Raines Individual Corporate DirectorBoard Member Jul 28, 2010
Greg Nenninger Individual Corporate DirectorBoard Member Nov 1, 2004
Cathi Greer Individual Corporate DirectorBoard Member Dec 1, 2006
Laura Griffin Individual Corporate DirectorBoard Member Jul 1, 2016
Cindy Beussink Individual Corporate DirectorBoard Member Nov 8, 2008
Val Crader Individual Corporate DirectorBoard Member Aug 1, 2011
Rick Francis Individual Corporate OfficerCeo Apr 1, 2024
Glynda J Burford Individual Corporate DirectorBoard Member Aug 1, 2015
Cross Trails Medical Center Organization, Cape Girardeau, MO Non-profit 5% Or Greater Direct Ownership Interest Jun 19, 2023 100%
Sheila Pruitt Individual W-2 Managing Employee May 26, 2010

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Cross Trails Medical CenterPerryville, MO, CCN 261068 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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": "1687824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1033895628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S BROADVIEW ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637035725",
            "telephone_number": "573-332-0808",
            "fax_number": "573-339-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 GOLDEN STREET",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63703",
            "telephone_number": "573-339-1196",
            "fax_number": "573-339-9378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSS TRAILS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSS TRAILS MEDICAL CENTER",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "573-332-0808"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.