NPIMap

Organization Active NPI

Golden Valley Memorial Hospital District

Doing business as Golden Valley Medical - Osceola

  • Rural Health Clinic/Center
  • Osceola, MO
National Provider Identifier
1124437918
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
066060 Issued in MO
Legal business name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Doing business as
Golden Valley Medical - Osceola
Practice address
675 3Rd St
Osceola, MO 64776-2934
Phone
(417) 646-2234
NPI assigned
Aug 6, 2014
Last updated
Mar 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Craig ThompsonNPI 1841254091
Title
Ceo
Phone
(660) 885-5511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 066060 MO Primary
Family Nurse Practitioner 363LF0000X 066060 MO

Addresses

Primary practice location

675 3Rd St
Osceola, MO 64776-2934

Mailing address

675 3Rd St
Osceola, MO 64776-2934
Phone (417) 646-2234

Other names 1

  • Golden Valley Medical - Osceola Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040407001299 MO Part B Supplier - Clinic/Group Practice 4688561814 Receives reassigned benefits from 227 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clinton, MO; Osceola, MO; Warsaw, MO; Windsor, MO
O20140908000899 MO Part A Provider - Rural Health Clinic 4688561814 Practice locations: Osceola, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124437918. Details of each certification follow.

Rural health clinic certification: CCN 268725

Legal name
GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT
Doing business as
GOLDEN VALLEY MEDICAL - OSCEOLA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 2015
Last certification
Feb 15, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
675 3Rd St
Osceola, MO 64776-2934
Related CCNs
260175

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 7

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
26D2082813Golden Valley Medical-Osceola675 Third Street, Osceola, MO 64776AccreditationFeb 9, 2028

National Provider Directory

National Provider Directory
Tax ID family
GVMH Emergency Physicians9 organizations share this tax ID, including this one
Part of
GVMH Emergency Physicians

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 7

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

NameRoleSinceShare
Mackenzie Conner Individual W-2 Managing EmployeeMedical Staff Coordinator Jul 10, 2025
William R Kelsay Individual Corporate OfficerVice Chairman/Board Member Oct 1, 2014 100%
George Lowe Individual Corporate OfficerTreasurer/Board Member Oct 1, 2014 100%
Tammy Nadler Individual Corporate OfficerCfo Jan 1, 2017
Golden Valley Memorial Hospital District Organization, Clinton, MO 5% Or Greater Direct Ownership Interest Oct 1, 2014 100%
Tim Glasscock Individual Corporate OfficerChairman/Board Member Oct 1, 2014 100%
Danny Eidson Individual Corporate OfficerBoard Member Oct 1, 2014 100%

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
Golden Valley Medical-WarsawWarsaw, MO, CCN 268588 Rural health clinic Operational/Managerial Control
Other		 Apr 4, 2004
Apr 4, 2004

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.

Practitioners & affiliated clinicians

Practitioners 7

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": "1407283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1124437918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 3RD ST",
            "city": "OSCEOLA",
            "state": "MO",
            "postal_code": "647762934",
            "telephone_number": "417-646-2234",
            "fax_number": "660-890-8479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 3RD ST",
            "city": "OSCEOLA",
            "state": "MO",
            "postal_code": "647762934",
            "telephone_number": "417-646-2234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOLDEN VALLEY MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2014-08-06",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-885-5511"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "066060",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "066060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Golden Valley Medical - Osceola",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osceola, MO

Sources for this page

Verify at the official NPI Registry.