Northeast Missouri Health Council Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Milan, MO
NPI 1144366154 · NPPES record last updated Jun 24, 2011
Key facts
- NPI
- 1144366154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- NORTHEAST MISSOURI HEALTH COUNCIL INC
- Practice address
- 52334 Business Highway 5
Milan, MO 63556-3040 - Phone
- (660) 265-1042
- Fax
- (660) 265-1043
- NPI assigned
- Jan 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Andrew H. Grimm
- Title
- Executive Director
- Phone
- (660) 627-5757
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 12
Practitioners 21
-
Heather R Martin, D.O.
-
Chante McKim, FNP
-
Joseph W Novinger, D.O.
-
Carolyn Allisa Snyder, R.D., L.D.
-
Brent D Speak, DO
-
Cassie Marie Tilton, NP-C
-
April Winkler, FNP-BC
-
Alisa Beth Fajkus, CNM
-
Melanie S. Grgurich, D.O.
-
Julia R Knapp, FNP
-
Craig E McCoy, D.O.
-
Beth M Schrage, RNCSFNP
-
Amanda Dawn Wilford, FNP-BC
-
Margaret Wilson, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0985653 | Northeast Missouri Family Health | Certificate of waiver | Apr 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO
Federally qualified health center certification: CCN 261866
- Legal name
- NORTHEAST MISSOURI HEALTH COUNCIL INC
- Doing business as
- NORTHEAST FAMILY HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 18, 2003
- Last certification
- Jun 18, 2003
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 22, 1968 in MO
- Enrollment address
- 52334 Business Highway 5
Milan, MO 63556-3040
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Chad Sawyer |
Corporate Director | Jan 23, 2020 | |
| Tammi Propst |
W-2 Managing Employee | Jun 1, 2006 | |
| Jeffrey Doss |
Corporate Director |
Jun 15, 2009 | |
| Carolyn Ranee Brayton |
Corporate Director | Jan 23, 2023 | |
| Walla Derosear |
Corporate Director |
Mar 1, 2012 | |
| Ashley Hartman |
W-2 Managing Employee | Jan 1, 2014 | |
| David Richard Rector |
Corporate Director |
Apr 22, 2003 | |
| Karen Ann Lumley |
Corporate Director |
Apr 22, 2003 | |
| Tiffany Labeth |
Corporate Director |
Aug 22, 2013 | |
| Phil McIntosh |
Corporate Director | Jan 23, 2020 | |
| Carolyn Primm |
Corporate Director |
May 26, 2011 | |
| Richard Gooch |
Corporate Director |
May 26, 2011 | |
| Pam Smith |
Corporate Director |
Sep 26, 2013 | |
| John Thibaut Heard |
Corporate Director |
Apr 23, 2003 | |
| Andrew Grimm |
Corporate Officer |
Sep 23, 2013 | |
| W-2 Managing Employee | Apr 1, 2009 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Macon Family Health |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 2, 2015 |
| Kahoka Dental |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 15, 2011 |
| Northeast Family Health Annex |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 15, 2011 |
| Memphis Community Health Center |
Federally qualified health center | Operational/Managerial Control | Apr 21, 1968 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030319000005 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 1658280805 | Practice locations: Milan, MO |
| O20040112000061 | MO | Part B Supplier - Clinic/Group Practice | 1658280805 |
Receives reassigned benefits from 27 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kirksville, MO |
| O20040430000892 | MO | Part B Supplier - Clinic/Group Practice | 1658280805 |
Receives reassigned benefits from 13 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Milan, MO |
National Provider Directory
- Tax ID family
- Northeast Missouri Fami
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 109328 | MO | |
| Obstetrics & Gynecology Physician |
207V00000X | 2009006697 | MO | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | MO | Yes |
Addresses
Primary practice location
52334 Business Highway 5
Milan, MO 63556-3040
Mailing address
1416 Crown Dr
Kirksville, MO 63501-2548
Phone (660) 627-5757
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 503351850 | Medicaid | MO |
Other names
- Northeast Missouri Family Health Clinic
Other providers in Milan, MO
- Sheila F King
- Ann E McDonald
- Milan SNF Opco LLC
- N & R of Milan
- Nancy Kay Scott Et Al PTR
- Preferred Family Health Care, Inc.
- Qmi LLC
- Kenneth Richards
- Rolling Hills Residential Care Facility, LLC
- Alexis Roman
All providers in Milan, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.