NPIMap

Organization Active NPI

South Central Missouri Community Health Center

Doing business as Four Rivers Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
National Provider Identifier
1164669172
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Doing business as
Four Rivers Community Health Center
Practice address
1081 E 18TH St
Rolla, MO 65401-2448
Phone
(573) 426-2407
NPI assigned
Jan 13, 2009
Last updated
Feb 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Authorized official

Name
Elizabeth Sparks
Title
HR Manager
Phone
(573) 426-2407

Specialties & licenses 1

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

Addresses

Primary practice location

1081 E 18TH St
Rolla, MO 65401-2448

Mailing address

1081 E 18TH St
Rolla, MO 65401-2448
Phone (573) 426-2407

Other names 1

  • Four Rivers Community Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bsparks@your-chc.org

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111013000097 MO Part B Supplier - Clinic/Group Practice 1355513581 Receives reassigned benefits from 27 practitioners
6 other NPIs on this enrollment
Practice locations: Rolla, MO; Cuba, MO; Salem, MO; Saint Robert, MO
O20140505001869 MO Part A Provider - Federally Qualified Health Center (FQHC) 1355513581 Practice locations: Rolla, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1164669172. Details of each certification follow.

Federally qualified health center certification: CCN 261070

Legal name
SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER
Doing business as
YOUR COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 4, 2014
Last certification
Mar 4, 2014
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Sep 24, 2007 in MO
Enrollment address
1081 E 18TH St
Rolla, MO 65401-2448

Federally qualified health center certification: CCN 261136

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
YOUR COMMUNITY HEALTH CENTER 18TH STREET LOCATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2017
Last certification
Jun 30, 2017
Ownership / control type
Non-profit – church related
Facility address
1081 East 18TH Street
Rolla, MO 65401

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

601 S McArthur St
Salem, MO 65560
Phone (573) 433-3559

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
South Central Missouri Community Health Center Organization, Rolla, MO Non-profit Operational/Managerial Control Sep 1, 2014 100%
Josephine Waltman Individual Corporate Director Sep 1, 2014
Kellie Bales Individual Corporate Director Sep 1, 2014
Deborah Frost Individual Corporate Director Sep 1, 2014
Stuart Gipson Individual Corporate Director Oct 18, 2019
W-2 Managing Employee Oct 18, 2019

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Four Rivers Community Health CenterRolla, MO, CCN 791034 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 11, 2023

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 30

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 30

NPI Registry JSON

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1164669172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 E 18TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012448",
            "telephone_number": "573-426-2407",
            "fax_number": "573-426-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1081 E 18TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654012448",
            "telephone_number": "573-426-2407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL MISSOURI COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-13",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "HR MANAGER",
        "authorized_official_telephone_number": "573-426-2407"
    },
    "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": "bsparks@your-chc.org",
            "affiliation": "N",
            "address_1": "1081 E 18th St",
            "city": "Rolla",
            "state": "MO",
            "country_code": "US",
            "postal_code": "654012448",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Four Rivers Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.