NPIMap

Organization Active NPI

Ozarks Resource Group

Doing business as Ozarks Community Health Center - Dental

  • Federally Qualified Health Center (FQHC)
  • Hermitage, MO
National Provider Identifier
1326453408
Registry record updated Jan 9, 2025
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 - Dental
Practice address
18627 Jackson St
Hermitage, MO 65668-8204
Phone
(417) 745-2134
Fax
(417) 745-2135
NPI assigned
Jun 26, 2014
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Clinical Social Worker 1041C0700X
General Practice Dentistry 1223G0001X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

18627 Jackson St
Hermitage, MO 65668-8204

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1235562836MedicaidMO

Other names 1

  • Ozarks Community Health Center - Dental Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140710000350 MO Part A Provider - Federally Qualified Health Center (FQHC) 6002068723 Practice locations: Hermitage, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326453408. Details of each certification follow.

Federally qualified health center certification: CCN 261082

Legal name
OZARKS RESOURCE GROUP
Doing business as
OZARKS COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 21, 2014
Last certification
Aug 21, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
18627 Jackson St
Hermitage, MO 65668-8204

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

Other organizations with this tax ID 6

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

Locations

18627 Jackson St
Hermitage, MO 65668
Phone (417) 745-2134

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Sherry Gunter Individual Corporate OfficerSecretary Jan 1, 2025
Scott D Crouch Individual Corporate OfficerCeo Apr 8, 2013 100%
Operational/Managerial Control Apr 8, 2013
Harold D Berry Individual Corporate DirectorDirector Jan 1, 2025
Jim Brown Individual Corporate DirectorDirector Jan 1, 2025
Gerald Simmons Individual Corporate OfficerVice President Jan 1, 2025
Ozarks Resource Group Organization, Hermitage, MO Operational/Managerial Control Apr 8, 2013 100%
Gail Aubuchon Individual Corporate DirectorDirector Jan 1, 2025
Charles Akins Individual Corporate OfficerTreasurer Jan 1, 2025
Mark Swigert Individual Corporate DirectorDirector Jan 1, 2025
Darin W Henderson Individual Corporate DirectorDirector Jan 1, 2025
Donald J Babb Individual Corporate OfficerPresident Jan 1, 2025
Kristin Custer Individual Corporate DirectorDirector Jan 1, 2025

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 - Miles for Smiles

    • Federally Qualified Health Center (FQHC)
    • Bolivar, MO
    • NPI 1164897161

    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 CenterUrbana, MO, CCN 261105 Federally qualified health center Operational/Managerial Control (100%) Apr 8, 2013
Ozarks Community Health CenterBolivar, MO, CCN 261114 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 - Miles for Smiles

    • Federally Qualified Health Center (FQHC)
    • Bolivar, MO
    • NPI 1164897161

    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.

NPI Registry JSON

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

{
    "created_epoch": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1326453408",
    "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": "18627 JACKSON ST",
            "city": "HERMITAGE",
            "state": "MO",
            "postal_code": "656688204",
            "telephone_number": "417-745-2134",
            "fax_number": "417-745-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARKS RESOURCE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235562836",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ozarks Community Health Center - Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hermitage, MO

Sources for this page

Verify at the official NPI Registry.