NPIMap

Organization Active NPI

Regional Health Care Clinic, Inc

Doing business as Katy Trail Community Health Cole Camp R-1

  • Federally Qualified Health Center (FQHC)
  • Cole Camp, MO
National Provider Identifier
1285288472
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGIONAL HEALTH CARE CLINIC, INC
Doing business as
Katy Trail Community Health Cole Camp R-1
Practice address
500 S Keeney St
Cole Camp, MO 65325-1059
Phone
(660) 668-4427
Fax
(660) 827-8992
NPI assigned
Jul 26, 2019
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
REGIONAL HEALTH CARE CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Michael Waller
Title
Ceo
Phone
(660) 668-4427

Specialties & licenses 1

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

Addresses

Primary practice location

500 S Keeney St
Cole Camp, MO 65325-1059

Mailing address

821 Westwood Dr
Sedalia, MO 65301-2102
Phone (660) 826-4774

Other names 1

  • Katy Trail Community Health Cole Camp R-1 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304001212 MO Part B Supplier - Clinic/Group Practice 8224926092 Receives reassigned benefits from 57 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cole Camp, MO; Green Ridge, MO; Marshall, MO; Sedalia, MO; Warsaw, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285288472. Details of each certification follow.

  • CCN 791005 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 791005

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
KATY TRAIL COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 11, 2020
Last certification
Jun 11, 2020
Ownership / control type
For profit – corporation
Facility address
500 S Keeney St
Cole Camp, MO 65325

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
Part of
Regional Health Care Clinic

Practitioners & affiliated clinicians

Practitioners 3

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": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1285288472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WESTWOOD DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012102",
            "telephone_number": "660-826-4774",
            "fax_number": "660-827-8992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S KEENEY ST",
            "city": "COLE CAMP",
            "state": "MO",
            "postal_code": "653251059",
            "telephone_number": "660-668-4427",
            "fax_number": "660-827-8992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGIONAL HEALTH CARE CLINIC, INC",
        "enumeration_date": "2019-07-26",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-668-4427"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katy Trail Community Health Cole Camp R-1",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Katy Trail Community Health Cole Camp R-1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cole Camp, MO

Sources for this page

Verify at the official NPI Registry.