NPIMap

Organization Active NPI

Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
National Provider Identifier
1134828676
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
Practice address
1111 Wornall St
Neosho, MO 64850-2618
Phone
(417) 782-6200
Fax
(417) 782-6210
NPI assigned
Feb 23, 2023
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Donald Michael McBride
Title
Ceo
Phone
(417) 451-9450

Owners & managing parties with NPI records 3

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

Practitioners 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230816001211 MO Part A Provider - Federally Qualified Health Center (FQHC) 8123918257 Practice locations: Neosho, MO

Federally qualified health center certification: CCN 261938

Legal name
OZARK TRI-COUNTY HEALTH CARE CONSORTIUM
Doing business as
ACCESS FAMILY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 14, 2023
Last certification
Aug 14, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1111 Wornall St
Neosho, MO 64850-2618

All disclosed owners & managing parties 21

Medicare enrollment files

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

NameRoleSinceShare
Julia M Leibbrand Individual W-2 Managing EmployeeProvider Enrollment Aug 26, 2013
Robin a Chapman Individual Corporate DirectorBoard Member Feb 23, 2023
Sheila R Long Individual Corporate OfficerCfo May 14, 2007
W-2 Managing EmployeeCfo May 14, 2007
Amanda K Bearden Individual Corporate DirectorBoard Member Aug 22, 2024
Keenan T Cortez Individual Corporate DirectorBoard Member Aug 26, 2021
Jerrie Wise Individual Corporate DirectorBoard Chair Jun 15, 1996
Kala M Smith Individual Corporate OfficerChief Dental Officer Jul 18, 2011
W-2 Managing EmployeeChief Dental Officer Jul 18, 2011
Joshua J Shackles Individual Corporate DirectorBoard Vice Chair Aug 26, 2021
Elizabeth Persons Individual Corporate DirectorBoard Secretary Nov 19, 2009
John M Seidel Individual Corporate DirectorBoard Member Feb 22, 2024
Charla J Miles Individual Corporate DirectorBoard Member Aug 22, 2024
Charles H Bentlage Individual Corporate DirectorBoard Member Jan 28, 2021
Allison Pruitt Individual Corporate DirectorBoard Member Feb 22, 2024
Jeffrey Elmore Individual Corporate OfficerCio May 30, 2017
W-2 Managing EmployeeCio May 30, 2017
Joseph Zuzul Individual Corporate DirectorBoard Member Jul 25, 2019
John D Paulson Individual Corporate OfficerChief Medical Officer Nov 27, 2023
W-2 Managing EmployeeMD; Nov 27, 2023
Christian Demasi Individual Corporate DirectorBoard Member Jul 25, 2014
Carrie E Foote Individual Corporate OfficerRisk Compliance & Quality Director Oct 2, 2006
W-2 Managing EmployeeRisk Compliance & Quality Director Oct 2, 2006
Rosario Keele Individual Corporate DirectorBoard Member Feb 22, 2024
Donald McBride Individual Corporate OfficerCfo Feb 27, 2006
W-2 Managing EmployeeCfo Feb 27, 2006
Carmen K Brown Individual Corporate DirectorBoard Member Mar 25, 2011

National Provider Directory

National Provider Directory
Tax ID family
Ozark Tri-County Consortium47 organizations share this tax ID, including this one

Other organizations with this tax ID 46

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

View all 46

Locations

1111 Wornall St
Neosho, MO 64850

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

1111 Wornall St
Neosho, MO 64850-2618

Mailing address

PO Box 758
Neosho, MO 64850-0758
Phone (417) 451-9450

Other names 1

NPPES NPI Registry
  • Access Family Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 17, 2023.

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1134828676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648500758",
            "telephone_number": "417-451-9450",
            "fax_number": "417-451-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 WORNALL ST",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502618",
            "telephone_number": "417-782-6200",
            "fax_number": "417-782-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK TRI-COUNTY HEALTH CARE CONSORTIUM",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-451-9450"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Access Family Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Access Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neosho, MO

Sources for this page

Verify at the official NPI Registry.