NPIMap

Organization Active NPI

Sgoh Acquisition Inc

  • Clinic/Center
  • Springfield, MO
National Provider Identifier
1114924768
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
4546 Issued in MO
Legal business name
SGOH ACQUISITION INC
Practice address
1540 E Evergreen St
Springfield, MO 65803-4300
Phone
(417) 823-2900
Fax
(417) 886-2774
NPI assigned
Jun 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Authorized official

Name
Mr. Paul Taylor
Title
Ceo
Phone
(417) 837-2000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 4546 MO Primary
Psychiatric Hospital 283Q00000X
Durable Medical Equipment & Medical Supplies 332B00000X 454-8 MO

Addresses

Primary practice location

1540 E Evergreen St
Springfield, MO 65803-4300

Mailing address

1540 E Evergreen St
Springfield, MO 65803-4300
Phone (417) 823-2900

Other practice location 1

112 N Webb St
Webb City, MO 64870-1916
Phone (417) 673-0366

Other identifiers 4

IdentifierTypeStateIssuer
540564408MedicaidMO
CR0762OtherMORR MEDICARE
121295105MedicaidAR
010564409MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040205000647 MO Part B Supplier - Clinic/Group Practice 5092616276 Receives reassigned benefits from 122 practitioners
Practice locations: Webb City, MO; Springfield, MO; Sparta, MO; South West City, MO; Rogersville, MO; Pineville, MO; Noel, MO; Neosho, MO…

Other NPIs with the same Medicare PAC ID 15

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

View all 15

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1102 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221

912B State Highway 59
Goodman, MO 64843
Phone (417) 364-7290

106 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

108 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

1355 Rocketdyne Rd
Neosho, MO 64850
Phone (417) 451-2240

125 Main St
Noel, MO 64854
Phone (417) 475-6151

412 US Hwy 71 Ste J
Och Pineville Medical Clinic
Pineville, MO 64856
Phone (417) 223-4290

109 N Broadway St
South West Cy, MO 64863
Phone (417) 752-3287

Ownership & related parties

All facility ownership & control disclosures 15

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

FacilityTypeRoleSince
Ozarks Community Hospital of GravetteGravette, AR, CCN 041331 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 16, 2008
Dec 31, 2021
Ozarks Community Hospital of GravetteGravette, AR, CCN 04Z331 Hospital Operational/Managerial Control (100%) Dec 31, 2021
Och McDonald County ClinicNoel, MO, CCN 268695 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Dec 19, 2013
Och Sparta ClinicSparta, MO, CCN 268726 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2014
Och Lawrence County ClinicMt. Vernon, MO, CCN 268597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Och Wellpointe Family Medical ClinicMarshfield, MO, CCN 268672 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Och Jasper County Clinic Carthage CampusCarthage, MO, CCN 268728 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 2015
Och Pineville Medical ClinicPineville, MO, CCN 268748 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Och Southwest City Community ClinicSouth West City, MO, CCN 268746 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Och Goodman Family ClinicGoodman, MO, CCN 268745 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Och Anderson Rural Health ClinicAnderson, MO, CCN 268747 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Och Newton County ClinicNeosho, MO, CCN 268778 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2020
Jan 1, 2020
Sgoh Acquisition IncRogers, AR, CCN 048529 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Aug 1, 2020
Aug 1, 2020
Och Webster County ClinicRogerville, MO, CCN 268609 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2015
Sgoh Acquisition IncDecatur, AR, CCN 048548 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 5, 2024
Aug 5, 2024

Owned or controlled facilities with NPI records 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 148

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 148

NPI Registry JSON

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721088000000",
    "number": "1114924768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 E EVERGREEN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034300",
            "telephone_number": "417-823-2900",
            "fax_number": "417-886-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 E EVERGREEN ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658034300",
            "telephone_number": "417-823-2900",
            "fax_number": "417-886-2774"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 N Webb St",
            "address_purpose": "LOCATION",
            "city": "Webb City",
            "state": "MO",
            "postal_code": "648701916",
            "country_code": "US",
            "telephone_number": "417-673-0366",
            "fax_number": "417-673-0093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SGOH ACQUISITION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-837-2000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MO",
            "license": "4546",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MO",
            "license": "454-8",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540564408",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CR0762",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121295105",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010564409",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.