Community Health Ctr of Central Missouri
Organization Active NPI Federally Qualified Health Center (FQHC) · California, MO
NPI 1205104403 · NPPES record last updated Nov 18, 2022
Key facts
- NPI
- 1205104403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
- Practice address
- 606 E Buchanan St
California, MO 65018-1910 - Phone
- (573) 632-2777
- Fax
- (573) 632-2769
- NPI assigned
- Dec 2, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Authorized official
- Name
- Toby Barnett
- Title
- Chief Fin Officer
- Phone
- (573) 632-0243
Owners & managing parties with NPI records 1
-
Crystal Sullivan, D.O.
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Practitioners 18
-
Brandi Nichols, MD
-
Abigail Aguilar, FNP-C
-
Mark A Rosales, DO
-
Crystal Sullivan, D.O.
-
Sheryl Denise Cade, FNP-BC
-
Crystal Lynn Cook, M.D.
-
Richard E Daugherty, M.D.
-
Shelly L Gudehus, FNP
-
Rebecca Lynn Hogg, M.D.
-
Megan King, D.O.
-
Gaurav Ashok Kulkarni, M.D.
-
April Lynn Miller, APRN-FNP
-
Morgan John Schiermeier, M.D.
-
Kristine Wall, NP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
Federally qualified health center certification: CCN 261056
- Legal name
- COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
- Doing business as
- COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Apr 2, 2012
- Last certification
- Apr 2, 2012
- Ownership / control type
- For profit – partnership
- Organization structure
- Other · Non-profit
- Incorporated
- Mar 17, 2003 in MO
- Enrollment address
- 606 E Buchanan St
California, MO 65018-1910
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Jackie Coleman |
Corporate Officer |
Oct 17, 2018 | |
| Kristi Campbell |
Corporate Officer |
Jan 1, 2015 | |
| Thomas a Luebbering |
Corporate Officer |
Oct 1, 2019 | |
| Linda Bickel |
Corporate Officer |
Jan 1, 2015 | |
| Amanda Grellner |
Corporate Officer |
Jan 1, 2015 | |
| Darrel King |
Corporate Officer |
Jan 1, 2015 | |
| Beverly Stafford |
Corporate Officer |
Jan 1, 2015 | |
| Linda McAnany |
Corporate Officer |
Jan 1, 2015 | |
| Debbie Hamler |
Corporate Officer |
Jan 1, 2015 | |
| Kathy Dothage |
Corporate Officer |
Jan 1, 2015 | |
| Thomas a Niekamp |
Corporate Officer |
Jan 1, 2015 | |
| Crystal L Sullivan |
Corporate Officer |
Jan 1, 2015 | |
| Christine Ellinger |
Corporate Officer |
Jan 1, 2015 | |
| Toby L Barnett |
Corporate Officer |
Jan 1, 2015 | |
| W-2 Managing Employee |
Jan 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050610000717 | MO | Part B Supplier - Clinic/Group Practice | 2062456015 |
Receives reassigned benefits from 31 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: California, MO; Fulton, MO; Jefferson City, MO; Linn, MO |
| O20120222000425 | MO | Part a Provider - Federally Qualified Health Center (FQHC) | 2062456015 | Practice locations: California, MO |
National Provider Directory
- Tax ID family
- Community Health Missouri
- Part of
- Community Health Missouri
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
606 E Buchanan St
California, MO 65018-1910
Mailing address
PO Box 104780
Jefferson City, MO 65110-4780
Phone (573) 632-0243
Other providers in California, MO
- Capital Region Medical Center
- Wanda L Carey
- Caring Hearts Home Health LLC.
- Children'S Therapy Center of Pettis County, Inc
- Community Connections of Moniteau County, Inc.
- Crystal Lynn Cook
- Alexandra Davidson
- Meghan Louise Dillon
- Donald J. Vanderfeltz
- Kenneth Michael Dudley
All providers in California, 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 Nov 18, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.