NPIMap

Organization Active NPI

Rural Alliance for Better Family Health

Doing business as Southern Missouri Community Health Center

  • Federally Qualified Health Center (FQHC)
  • West Plains, MO
National Provider Identifier
1144280132
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RURAL ALLIANCE FOR BETTER FAMILY HEALTH
Doing business as
Southern Missouri Community Health Center
Southern Missouri Community Health Center West Plains Clinic
Practice address
1137 Independence Dr
West Plains, MO 65775
Phone
(417) 255-8464
Fax
(417) 255-9741
NPI assigned
Mar 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Authorized official

Name
Bryan Adcock
Title
Ceo
Phone
(417) 255-8464

Specialties & licenses 1

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

Addresses

Primary practice location

1137 Independence Dr
West Plains, MO 65775

Mailing address

1137 Independence Drive
West Plains, MO 65775
Phone (417) 255-8464

Other practice location 1

1113 Independence Dr
West Plains, MO 65775-4221
Phone (417) 255-8464

Other names 2

  • Southern Missouri Community Health Center Doing business as
  • Southern Missouri Community Health Center West Plains Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smchc@myezyaccess.com Direct

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030110000001 MO Part A Provider - Federally Qualified Health Center (FQHC) 6103734058 Practice locations: West Plains, MO
O20040316001026 MO Part B Supplier - Clinic/Group Practice 6103734058 Receives reassigned benefits from 12 practitioners
4 other NPIs on this enrollment
Practice locations: Thayer, MO; West Plains, MO

Federally qualified health center certification: CCN 261863

Legal name
RURAL ALLIANCE FOR BETTER FAMILY HEALTH
Doing business as
SOUTHERN MISSOURI COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 10, 2003
Last certification
Jan 10, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 2001 in MO
Enrollment address
1137 Independence Dr
West Plains, MO 65775-4221

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Rural Alliance for Better5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1137 Independence Dr
West Plains, MO 65775
Phone (417) 255-8464

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Bryan Adcock Individual Corporate OfficerCeo Sep 30, 2019
W-2 Managing EmployeeCeo Sep 30, 2019
Angela Gargus Individual Corporate OfficerChief Financial Officer Mar 31, 2008
Connie Harris Individual Corporate DirectorBoard Member May 21, 2012
Connie Jean Pendergrass Individual Corporate DirectorBoard President Jul 2, 2001
Amber Squires Individual Corporate OfficerBoard Member Feb 28, 2022
Karen Perkins Individual Corporate DirectorBoard Member Dec 13, 2001
Tonya Woods Individual Corporate DirectorDirector Jun 27, 2016
Brittany Hunter Individual Corporate DirectorBoard Member Nov 18, 2019
Diana Pace Individual Corporate DirectorBoard Member Sep 22, 2008
Terry Newton Individual Corporate DirectorBoard Member Jan 25, 2021
Janis Gendron Individual Corporate DirectorBoard Member Jan 24, 2011

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1144280132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 INDEPENDENCE DRIVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "65775",
            "telephone_number": "417-255-8464",
            "fax_number": "417-255-9741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 INDEPENDENCE DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "65775",
            "telephone_number": "417-255-8464",
            "fax_number": "417-255-9741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1113 Independence Dr",
            "address_purpose": "LOCATION",
            "city": "West Plains",
            "state": "MO",
            "postal_code": "657754221",
            "country_code": "US",
            "telephone_number": "417-255-8464",
            "fax_number": "417-255-9732",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RURAL ALLIANCE FOR BETTER FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "ADCOCK",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-255-8464"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smchc@myezyaccess.com",
            "affiliation": "N",
            "endpointDescription": "Secure direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Free Text",
            "address_1": "1113 Independence Dr",
            "city": "West Plains",
            "state": "MO",
            "country_code": "US",
            "postal_code": "657754221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Southern Missouri Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Missouri Community Health Center West Plains Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Plains, MO

Sources for this page

Verify at the official NPI Registry.