NPIMap

Organization Active NPI

Community Health Ctr of Central Missouri

  • Federally Qualified Health Center (FQHC)
  • California, MO
National Provider Identifier
1205104403
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Nov 18, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CTR OF CENTRAL MISSOURIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
Toby Barnett
Title
Chief Fin Officer
Phone
(573) 632-0243

Specialties & licenses 1

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

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205104403. Details of each certification follow.

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
OtherNon-profit
Incorporated
Mar 17, 2003 in MO
Enrollment address
606 E Buchanan St
California, MO 65018-1910

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center of Central Missouri5 organizations share this tax ID, including this one
Part of
Community Health Center of Central Missouri

Other organizations with this tax ID 4

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

Locations

104 N Gerhart Rd
California, MO 65018
Phone (573) 632-0243

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jackie Coleman Individual Corporate OfficerBoard Member Oct 17, 2018
Kristi Campbell Individual Corporate OfficerBoard Member Jan 1, 2015
Thomas a Luebbering Individual Corporate OfficerBoard Member Oct 1, 2019
Linda Bickel Individual Corporate OfficerBoard Member Jan 1, 2015
Amanda Grellner Individual Corporate OfficerBoard Member Jan 1, 2015
Darrel King Individual Corporate OfficerBoard Member Jan 1, 2015
Beverly Stafford Individual Corporate OfficerBoard Member Jan 1, 2015
Linda McAnany Individual Corporate OfficerBoard Member Jan 1, 2015
Debbie Hamler Individual Corporate OfficerBoard Member Jan 1, 2015
Kathy Dothage Individual Corporate OfficerBoard Member Jan 1, 2015
Thomas a Niekamp Individual Corporate OfficerBoard Member Jan 1, 2015
Crystal L Sullivan Individual Corporate OfficerCco Jan 1, 2015
Christine Ellinger Individual Corporate OfficerBoard Member Jan 1, 2015
Toby L Barnett Individual Corporate OfficerCfo Jan 1, 2015
W-2 Managing EmployeeCfo Jan 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1205104403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104780",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104780",
            "telephone_number": "573-632-0243",
            "fax_number": "573-632-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E BUCHANAN ST",
            "city": "CALIFORNIA",
            "state": "MO",
            "postal_code": "650181910",
            "telephone_number": "573-632-2777",
            "fax_number": "573-632-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CTR OF CENTRAL MISSOURI",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CTR OF CENTRAL MISSOURI",
        "enumeration_date": "2011-12-02",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "BARNETT",
        "authorized_official_first_name": "TOBY",
        "authorized_official_title_or_position": "CHIEF FIN OFFICER",
        "authorized_official_telephone_number": "573-632-0243"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in California, MO

Sources for this page

Verify at the official NPI Registry.