NPIMap

Organization Active NPI

Regional Health Care Clinic Inc

Doing business as Katy Trail Community Health Warsaw

  • Federally Qualified Health Center (FQHC)
  • Warsaw, MO
National Provider Identifier
1053533539
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
Katy Trail Community Health Warsaw
Practice address
17571 N Dam Access Rd
Warsaw, MO 65355-6396
Phone
(660) 438-2717
Fax
(660) 438-2313
NPI assigned
May 3, 2007
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Ms. Mike Waller
Title
Ceo
Phone
(660) 438-2717

Specialties & licenses 1

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

Addresses

Primary practice location

17571 N Dam Access Rd
Warsaw, MO 65355-6396

Mailing address

821 Westwood Dr
Sedalia, MO 65301
Phone (660) 826-4774

Other names 1

  • Katy Trail Community Health Warsaw Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304001212 MO Part B Supplier - Clinic/Group Practice 8224926092 Receives reassigned benefits from 57 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cole Camp, MO; Green Ridge, MO; Marshall, MO; Sedalia, MO; Warsaw, MO
O20060907000591 MO Part A Provider - Federally Qualified Health Center (FQHC) 8224926092 1 other NPI on this enrollment
Practice locations: Warsaw, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053533539. Details of each certification follow.

Federally qualified health center certification: CCN 261005

Legal name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
KATY TRAIL COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2006
Last certification
Oct 17, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 1999 in MO
Enrollment address
17571 N Dam Access Rd
Warsaw, MO 65355-6396

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Michelle Hendricks Individual Corporate OfficerCfo Jan 1, 2024
Michael Waller Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1053533539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WESTWOOD DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "65301",
            "telephone_number": "660-826-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17571 N DAM ACCESS RD",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653556396",
            "telephone_number": "660-438-2717",
            "fax_number": "660-438-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-438-2717",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katy Trail Community Health Warsaw",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warsaw, MO

Sources for this page

Verify at the official NPI Registry.