NPIMap

Organization Active NPI

Harrison County Community Hospital District

Doing business as North Harrison Medical Clinic

  • Rural Health Clinic/Center
  • Eagleville, MO
National Provider Identifier
1114348083
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Doing business as
North Harrison Medical Clinic
Practice address
16027 Locust Street
Eagleville, MO 64442
Phone
(660) 867-5111
Fax
(660) 867-3111
NPI assigned
Dec 19, 2013
Last updated
Mar 18, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Authorized official

Name
Ms. Christina Gillespie
Title
Chief Executive Officer
Phone
(660) 425-2211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

16027 Locust Street
Eagleville, MO 64442

Mailing address

16027 Locust Street
Eagleville, MO 64442
Phone (660) 867-5111

Other names 1

  • North Harrison Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040907001047 MO Part B Supplier - Clinic/Group Practice 4587630926 Receives reassigned benefits from 33 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bethany, MO; Eagleville, MO; Pattonsburg, MO
O20140826000783 MO Part A Provider - Rural Health Clinic 4587630926 Practice locations: Eagleville, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114348083. Details of each certification follow.

Rural health clinic certification: CCN 268714

Legal name
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Doing business as
NORTH HARRISON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2014
Last certification
Apr 6, 2021
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
16027 Locust St
Eagleville, MO 64442-7130
Related CCNs
261312

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

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 5

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
26D2082457North Harrison Medical Clinic16027 Locust Street, Eagleville, MO 64442Certificate of waiverAug 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Harrison County District4 organizations share this tax ID, including this one
Part of
Harrison County District

Other organizations with this tax ID 3

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

Locations

2600 Miller St
Bethany, MO 64424
Phone (660) 425-2211

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Christina Gillespie Individual Corporate OfficerChief Executive Officer Jan 30, 2017 100%
W-2 Managing EmployeeChief Executive Officer Jan 30, 2017 100%
Operational/Managerial ControlChief Executive Officer Jan 30, 2017 100%
Sheila Robertson Individual Corporate DirectorDirector Apr 1, 2000 100%
Kenneth Chad Lambert Individual W-2 Managing EmployeeMD; Sep 24, 2012
Alicia Hendren Individual Corporate OfficerChief Operating Officer Nov 23, 1998
W-2 Managing EmployeeChief Operating Officer Nov 23, 1998
Operational/Managerial ControlChief Operating Officer Nov 23, 1998
Harrison County Community Hospital District Organization, Bethany, MO 5% Or Greater Direct Ownership Interest Jul 14, 2014 100%
Operational/Managerial Control Jul 14, 2014 100%
Glenda Ellis Individual Corporate DirectorDirector Apr 5, 2016 100%
Amanda Gruver Individual W-2 Managing EmployeeAdministrative Assistant May 1, 2025
Jamie L Smith Individual Corporate DirectorBusiness Office Manager Oct 1, 2013
W-2 Managing Employee Sep 28, 2010
Linda Eivins Individual Operational/Managerial ControlSecretary on Board of Directors Jan 1, 2020
Glenn Cox Individual Corporate DirectorBoard Member Jan 1, 2019
Kelvin Cox Individual Operational/Managerial ControlBoard of Director Oct 1, 2024
Renee Fordyce Individual Corporate DirectorDirector Apr 1, 2000 100%

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Harrison County Community HospitalBethany, MO, CCN 261312 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2001
Oct 1, 2001
HCCH Medical ClinicBethany, MO, CCN 268649 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 3, 2010
May 3, 2010
HCCH Pattonsburg Medical ClinicPattonsburg, MO, CCN 268813 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2025
Jun 1, 2025

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1387411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1114348083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16027 LOCUST STREET",
            "city": "EAGLEVILLE",
            "state": "MO",
            "postal_code": "64442",
            "telephone_number": "660-867-5111",
            "fax_number": "660-867-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16027 LOCUST STREET",
            "city": "EAGLEVILLE",
            "state": "MO",
            "postal_code": "64442",
            "telephone_number": "660-867-5111",
            "fax_number": "660-867-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT",
        "enumeration_date": "2013-12-19",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "GILLESPIE",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "660-425-2211",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Harrison Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Harrison Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagleville, MO

Sources for this page

Verify at the official NPI Registry.