NPIMap

Organization Active NPI

Bothwell Regional Health Center

  • Family Medicine Physician
  • Warsaw, MO
National Provider Identifier
1043399371
Registry record updated Apr 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOTHWELL REGIONAL HEALTH CENTER
Practice address
1765 Commercial St
Warsaw, MO 65355-3096
Phone
(660) 468-3800
Fax
(660) 438-6525
NPI assigned
Nov 6, 2006
Organization subpart
Yes
Parent organization
BOTHWELL REGIONAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2014

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

Authorized official

Name
James A Robertson
Title
Cfo
Phone
(660) 827-9482

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1765 Commercial St
Warsaw, MO 65355-3096

Mailing address

601 E 14TH Street
PO Box 1706
Sedalia, MO 65301-5972
UG
Phone (660) 826-8833

Other identifiers 2

IdentifierTypeStateIssuer
505432005MedicaidMO
22602015OtherMOBLUE CROSS BLUE SHIELD OF KC

Other names 1

  • BHC - Truman Lake Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000246 MO Part B Supplier - Clinic/Group Practice 6103714126 Receives reassigned benefits from 206 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, MO; Sedalia, MO; Lincoln, MO; Cole Camp, MO
O20040916001336 MO Part A Provider - Rural Health Clinic 6103714126 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, MO

Rural health clinic certification: CCN 268598

Legal name
BOTHWELL REGIONAL HEALTH CENTER
Doing business as
BOTHWELL HEALTH CENTER-TRUMAN LAKE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2006
Last certification
Dec 10, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1765 Commercial St
Warsaw, MO 65355-3096
Related CCNs
260009

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
Osage Valley Medical Ce

Locations

1765 Commercial St
Warsaw, MO 65355
Phone (660) 438-6800

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Connie McLaughlin Individual Corporate OfficerBoard Member Jun 5, 2023
Lori L Wightman Individual Corporate OfficerCeo Jun 1, 2019
Jo Lynn Turley Individual Corporate DirectorBoard Member Dec 20, 2022
Steven R Davis Individual Corporate OfficerCfo Jan 1, 2016
Andrew Dawson Individual Corporate DirectorBoard Member Apr 26, 2022
Philip J Fracica Individual Corporate OfficerChief Medical Officer Nov 16, 2015
Cassie Elizabeth Brown Individual Corporate DirectorBoard Member May 6, 2024
Michael Murders Individual Corporate DirectorBoard Member Dec 20, 2022
Lisa Irwin Individual Corporate OfficerExecutive Director of HR Jan 1, 2019
Marvin Smoot Individual Corporate OfficerVP Clinic Operations Nov 24, 2023
Matthew Wirt Individual Corporate OfficerBoard Member Jul 7, 2025
Diana L Oconnor Individual W-2 Managing EmployeeDirector of Patient Finance Serv Apr 16, 2013
Bothwell Regional Health Center Organization, Sedalia, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1998 100%
Terri McCarthy Individual W-2 Managing EmployeeDirector Clinic Financials Jan 1, 2019
Gregory a Doak Individual Corporate DirectorBoard Member Dec 20, 2022
Deidre Esquivel Individual Corporate DirectorBoard Member Jul 7, 2020
Michele Laas Individual Corporate OfficerChief Nursing Officer Feb 28, 2022

Owners & managing parties with NPI records 9

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397692800000",
    "number": "1043399371",
    "addresses": [
        {
            "country_code": "UG",
            "country_name": "Uganda",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "601 E 14TH STREET",
            "address_2": "PO BOX 1706",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653015972",
            "telephone_number": "660-826-8833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 COMMERCIAL ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653553096",
            "telephone_number": "660-468-3800",
            "fax_number": "660-438-6525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOTHWELL REGIONAL HEALTH CENTER",
        "enumeration_date": "2006-11-06",
        "last_updated": "2014-04-17",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-827-9482"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505432005",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF KC",
            "identifier": "22602015",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHC - Truman Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warsaw, MO

Sources for this page

Verify at the official NPI Registry.