NPIMap

Organization Active NPI

Rural Alliance for Better Family Health

Doing business as Southern Missouri Community Health Center Thayer Clinic

  • Federally Qualified Health Center (FQHC)
  • Thayer, MO
National Provider Identifier
1164488680
Registry record updated Jan 15, 2015
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 Thayer Clinic
Practice address
RR 3 Box 3707
Thayer, MO 65791-9306
Phone
(417) 264-2990
Fax
(417) 264-2993
NPI assigned
Apr 24, 2006
Last updated
Jan 15, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
RURAL ALLIANCE FOR BETTER FAMILY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Patricia J Richards
Title
Ceo
Phone
(417) 255-8464

Specialties & licenses 1

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

Addresses

Primary practice location

RR 3 Box 3707
Thayer, MO 65791-9306

Mailing address

1137 Independence Dr
West Plains, MO 65775-4221
Phone (417) 255-8464

Other names 1

  • Southern Missouri Community Health Center Thayer 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
O20040316001026 MO Part B Supplier - Clinic/Group Practice 6103734058 Receives reassigned benefits from 12 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thayer, MO; West Plains, MO
O20050216000619 MO Part A Provider - Federally Qualified Health Center (FQHC) 6103734058 Practice locations: Thayer, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164488680. Details of each certification follow.

Federally qualified health center certification: CCN 261882

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
Mar 18, 2005
Last certification
Mar 18, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 2001 in MO
Enrollment address
9394 US 63
Thayer, MO 65791-9448
Related CCNs
261863

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
Part of
Rural Alliance for Better

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 12

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 Employee Sep 30, 2019
Angela Gargus Individual W-2 Managing EmployeeChief Financial Officer Mar 31, 2008
Connie Harris Individual Corporate DirectorBoard Member May 21, 2012
Connie Jean Pendergrass Individual Corporate DirectorBoard Member Jul 2, 2001
Amber Squires Individual Corporate DirectorBoard Member Feb 28, 2022
Karen Perkins Individual Corporate DirectorBoard Member Dec 13, 2001
Brent H Campbell Individual Corporate DirectorBoard Member Sep 25, 2023
Tonya Woods Individual Corporate DirectorDirector Jun 27, 2016
Diana Pace Individual Corporate DirectorBoard Member Sep 22, 2008
Alex O'Neil Individual Corporate DirectorBoard Member Feb 28, 2022
Terry Newton Individual Corporate DirectorBoard Member Jan 25, 2021
Janis Gendron Individual Corporate DirectorBoard Member Jan 24, 2011

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": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1164488680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 INDEPENDENCE DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754221",
            "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": "RR 3 BOX 3707",
            "city": "THAYER",
            "state": "MO",
            "postal_code": "657919306",
            "telephone_number": "417-264-2990",
            "fax_number": "417-264-2993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL ALLIANCE FOR BETTER FAMILY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RURAL ALLIANCE FOR BETTER FAMILY HEALTH",
        "enumeration_date": "2006-04-24",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "J",
        "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": [],
    "other_names": [
        {
            "organization_name": "Southern Missouri Community Health Center Thayer Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thayer, MO

Sources for this page

Verify at the official NPI Registry.