NPIMap

Organization Active NPI

Ozarks Resource Group

Doing business as Ozarks Community Health Center - Miles for Smiles

  • Federally Qualified Health Center (FQHC)
  • Bolivar, MO
National Provider Identifier
1164897161
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OZARKS RESOURCE GROUP
Doing business as
Ozarks Community Health Center - Miles for Smiles
Practice address
203 E. Broadway St.
Bolivar, MO 65613
Phone
(417) 328-6334
Fax
(417) 326-8111
NPI assigned
Dec 2, 2015
Last updated
May 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OZARKS RESOURCE GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Authorized official

Name
Mr. Scott D Crouch
Title
Ceo
Phone
(417) 745-2121

Specialties & licenses 1

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

Addresses

Primary practice location

203 E. Broadway St.
Bolivar, MO 65613

Mailing address

PO Box 125
Hermitage, MO 65668-0125
Phone (417) 745-2121

Other identifiers 1

IdentifierTypeStateIssuer
1639421050MedicaidMO

Other names 1

  • Ozarks Community Health Center - Miles for Smiles Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160106000765 MO Part A Provider - Federally Qualified Health Center (FQHC) 6002068723 Practice locations: Bolivar, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164897161. Details of each certification follow.

Federally qualified health center certification: CCN 261114

Legal name
OZARKS RESOURCE GROUP
Doing business as
OZARKS COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 5, 2016
Last certification
Jan 5, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
203 E Broadway St
Bolivar, MO 65613-1623

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Ozarks Resource Group7 organizations share this tax ID, including this one
Part of
Ozarks Resource Group

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Scott D Crouch Individual Corporate OfficerCeo Apr 8, 2013 100%
Operational/Managerial ControlCeo Apr 8, 2013 100%
Ozarks Resource Group Organization, Hermitage, MO Corporation, Non-profit Operational/Managerial Control Apr 8, 2013 100%

Owners & managing parties with NPI records 4

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

  • Ozarks Resource Group

    dba Ozarks Community Health Center - Dental

    • Federally Qualified Health Center (FQHC)
    • Hermitage, MO
    • NPI 1326453408

    Operational/Managerial Control

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Urbana, MO
    • NPI 1487024667

    Operational/Managerial Control

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Hermitage, MO
    • NPI 1639421050

    Operational/Managerial Control

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Urbana, MO
    • NPI 1659942027

    Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Ozark Community Health CenterHermitage, MO, CCN 261058 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2012
Ozarks Community Health CenterHermitage, MO, CCN 261082 Federally qualified health center Operational/Managerial Control (100%) Apr 8, 2013
Ozarks Community Health CenterUrbana, MO, CCN 261105 Federally qualified health center Operational/Managerial Control (100%) Apr 8, 2013
Ozarks Community Health Center - UrbanaUrbana, MO, CCN 791169 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 23, 2006

Owned or controlled facilities with NPI records 4

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

  • Ozarks Resource Group

    dba Ozarks Community Health Center - Dental

    • Federally Qualified Health Center (FQHC)
    • Hermitage, MO
    • NPI 1326453408

    Operational/Managerial Control

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Urbana, MO
    • NPI 1487024667

    Operational/Managerial Control

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Hermitage, MO
    • NPI 1639421050

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Ozarks Resource Group

    dba Ozarks Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Urbana, MO
    • NPI 1659942027

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 4

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

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": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1164897161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 125",
            "city": "HERMITAGE",
            "state": "MO",
            "postal_code": "656680125",
            "telephone_number": "417-745-2121",
            "fax_number": "417-745-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 E. BROADWAY ST.",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "65613",
            "telephone_number": "417-328-6334",
            "fax_number": "417-326-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARKS RESOURCE GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OZARKS RESOURCE GROUP",
        "enumeration_date": "2015-12-02",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "CROUCH",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-745-2121",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639421050",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ozarks Community Health Center - Miles for Smiles",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ozarks Community Health Center - Miles for Smiles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolivar, MO

Sources for this page

Verify at the official NPI Registry.