NPIMap

Organization Active NPI

Harrison County Community Hospital District

Doing business as Bethany Medical Clinic

  • Rural Health Clinic/Center
  • Bethany, MO
National Provider Identifier
1154645745
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Doing business as
Bethany Medical Clinic
HCCH Medical Clinic
Practice address
3202 Miller St
Bethany, MO 64424-2713
Phone
(660) 425-3154
Fax
(660) 425-6663
NPI assigned
Mar 25, 2010
Last updated
Sep 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Authorized official

Name
Christina Gillespie
Title
Chief Executive Officer
Phone
(660) 425-2211

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

3202 Miller St
Bethany, MO 64424-2713

Mailing address

3202 Miller St
Bethany, MO 64424-2713
Phone (660) 425-3154

Other names 2

  • Bethany Medical Clinic Doing business as
  • HCCH Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040907001047 MO Part B Supplier - Clinic/Group Practice 4587630926 Receives reassigned benefits from 33 practitioners
6 other NPIs on this enrollment
Practice locations: Bethany, MO; Eagleville, MO; Pattonsburg, MO
O20110929000628 MO Part A Provider - Rural Health Clinic 4587630926 Practice locations: Bethany, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154645745. Details of each certification follow.

Rural health clinic certification: CCN 268649

Legal name
HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT
Doing business as
HCCH MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 3, 2010
Last certification
Apr 6, 2021
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
3202 Miller St
Bethany, MO 64424-2713

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 5

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
26D0444790HCCH Medical Clinic3202 Miller Street, Bethany, MO 64424Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Part of
Harrison Co Community H

Locations

2600 Miller St
Bethany, MO 64424
Phone (660) 425-0253

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Christina Gillespie Individual Corporate OfficerChief Executive Officer Jan 30, 2017 100%
W-2 Managing EmployeeChief Executive Officer Jan 30, 2017 100%
Operational/Managerial ControlChief Executive Officer Jan 30, 2017 100%
Sheila Robertson Individual Corporate Director May 3, 2010
Kenneth Chad Lambert Individual W-2 Managing EmployeeMD; Sep 24, 2012
Alicia Hendren Individual Corporate OfficerChief Operating Officer Nov 23, 1998
Corporate DirectorChief Operating Officer Nov 23, 1998
W-2 Managing EmployeeChief Operating Officer Nov 23, 1998
Harrison County Community Hospital District Organization, Bethany, MO 5% Or Greater Direct Ownership Interest May 3, 2010 100%
Operational/Managerial Control May 3, 2010 100%
Glenda Ellis Individual Corporate DirectorDirector Apr 5, 2016 100%
Amanda Gruver Individual W-2 Managing EmployeeAdministrative Assistant May 1, 2025
Jamie L Smith Individual Corporate DirectorBusiness Office Manager Sep 28, 2010
W-2 Managing Employee Sep 28, 2010
Linda Eivins Individual Operational/Managerial ControlSecretary on Board of Directors Jan 1, 2020
Alan Hamilton Individual Corporate DirectorBoard Member Jan 1, 2019
Glenn Cox Individual Corporate Director May 3, 2010
Kelvin Cox Individual Operational/Managerial ControlBoard of Director Oct 1, 2024
Renee Fordyce Individual Corporate Director May 23, 2011

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Harrison County Community HospitalBethany, MO, CCN 261312 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2001
Oct 1, 2001
North Harrison Medical ClinicEagleville, MO, CCN 268714 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 14, 2014
Jul 14, 2014
HCCH Pattonsburg Medical ClinicPattonsburg, MO, CCN 268813 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2025
Jun 1, 2025

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1154645745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3202 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242713",
            "telephone_number": "660-425-3154",
            "fax_number": "660-425-6663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 MILLER ST",
            "city": "BETHANY",
            "state": "MO",
            "postal_code": "644242713",
            "telephone_number": "660-425-3154",
            "fax_number": "660-425-6663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HARRISON COUNTY COMMUNITY HOSPITAL DISTRICT",
        "enumeration_date": "2010-03-25",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "GILLESPIE",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "660-425-2211"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethany Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HCCH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethany, MO

Sources for this page

Verify at the official NPI Registry.