NPIMap

Organization Active NPI

Western Missouri Medical Center

Doing business as Western Missouri Family Healthcare - Concordia

  • Rural Health Clinic/Center
  • Concordia, MO
National Provider Identifier
1215388293
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WESTERN MISSOURI MEDICAL CENTER
Doing business as
Western Missouri Family Healthcare - Concordia
Practice address
905 S Main St
Concordia, MO 64020
Phone
(660) 463-7966
Fax
(660) 463-7729
NPI assigned
Jun 30, 2016
Last updated
Nov 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

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

Authorized official

Name
Michael Dean Ohmart
Title
Cfo
Phone
(660) 262-7307

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

905 S Main St
Concordia, MO 64020

Mailing address

905 S Main St
Concordia, MO 64020-8335
Phone (660) 463-7966

Other names 1

  • Western Missouri Family Healthcare - Concordia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040616000777 MO Part B Supplier - Clinic/Group Practice 7416931506 Receives reassigned benefits from 138 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warrensburg, MO
O20091022000298 MO Part B Supplier - Clinic/Group Practice 5092852111 Receives reassigned benefits from 35 practitioners
2 other NPIs on this enrollment
Practice locations: Concordia, MO; Warrensburg, MO; Knob Noster, MO
O20190802000308 MO Part A Provider - Rural Health Clinic 5092852111 Practice locations: Concordia, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215388293. Details of each certification follow.

Rural health clinic certification: CCN 268775

Legal name
WESTERN MISSOURI MEDICAL CENTER
Doing business as
WESTERN MO FAMILY HEALTHCARE - CONCORDIA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 18, 2019
Last certification
Dec 18, 2019
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
905 S Main St
Concordia, MO 64020-8335
Related CCNs
260097

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 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Western Missouri Family Express Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

600 E Allen St
Knob Noster, MO 65336
Phone (660) 563-5555

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Rita White Individual Corporate DirectorTreasurer Aug 1, 2019
Larry W Purcell Individual Corporate DirectorChair Aug 1, 2019
Amanda Broderson Individual W-2 Managing EmployeeCredentialing Coordinator Jan 1, 2026
Lacey D Bredehoeft-Fiene Individual Corporate OfficerCfo Jan 15, 2026
Darinda J Dick Individual Corporate OfficerCeo Aug 1, 2019
Corporate DirectorCeo Aug 1, 2019
W-2 Managing EmployeeCeo Aug 1, 2019
Western Missouri Medical Center Organization, Warrensburg, MO 5% Or Greater Direct Ownership Interest Aug 1, 2019 100%
Greg Hassler Individual Corporate DirectorTrustee Aug 1, 2019

Owners & managing parties with NPI records 2

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1215388293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 S MAIN ST",
            "city": "CONCORDIA",
            "state": "MO",
            "postal_code": "640208335",
            "telephone_number": "660-463-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 S MAIN ST",
            "city": "CONCORDIA",
            "state": "MO",
            "postal_code": "64020",
            "telephone_number": "660-463-7966",
            "fax_number": "660-463-7729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MISSOURI MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-30",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "OHMART",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-262-7307"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Missouri Family Healthcare - Concordia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Missouri Family Healthcare - Concordia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concordia, MO

Sources for this page

Verify at the official NPI Registry.