NPIMap

Organization Active NPI

Advocates for a Healthy Community, Inc

Doing business as Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lebanon, MO
National Provider Identifier
1356032643
Registry record updated May 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ADVOCATES FOR A HEALTHY COMMUNITY, INC
Doing business as
Jordan Valley Community Health Center
Practice address
2020 Evergreen Pkwy
Lebanon, MO 65536-4611
Phone
(417) 334-8337
Fax
(417) 832-8275
NPI assigned
May 17, 2023
Last updated
May 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2023

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

Authorized official

Name
Kenneth Brooks Miller
Title
Ceo
Phone
(417) 851-1551

Specialties & licenses 1

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

Addresses

Primary practice location

2020 Evergreen Pkwy
Lebanon, MO 65536-4611

Mailing address

440 E Tampa St
Springfield, MO 65806-1131
Phone (417) 831-0150

Other names 1

  • Jordan Valley Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230802002183 MO Part A Provider - Federally Qualified Health Center (FQHC) 5395653562 Practice locations: Lebanon, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356032643. Details of each certification follow.

Federally qualified health center certification: CCN 261937

Legal name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Doing business as
JORDAN VALLEY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 1, 2023
Last certification
Aug 1, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 21, 1992 in MO
Enrollment address
2020 Evergreen Pkwy
Lebanon, MO 65536-4611

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jordan Valley Community33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Amy Poe Individual Corporate Officer Jun 21, 2021
Jeff Davis Individual Corporate Officer Jun 21, 2021
Yadira Howe Individual W-2 Managing EmployeeExecutive Vice President, Adm Mar 20, 2024
Kenneth B Miller Individual Corporate OfficerCeo Jun 19, 2001
Christy Wilson Individual W-2 Managing EmployeeDirector, Revenue Cycle Mar 20, 2024
Mendie Schoeller Individual Corporate Officer Jun 21, 2021
Matthew Stinson Individual Corporate OfficerCeo Jun 1, 2024
Trey Peck Individual Corporate Officer Jun 21, 2021
Kevin Gipson Individual Corporate Officer Jun 21, 2021
John Twitty Individual Corporate OfficerChair Jun 21, 2021
Phil Brown Individual Corporate OfficerBoard Member Jun 1, 2022
Richard Hardy Individual Corporate Officer Jun 21, 2021
Carol Dehaven Janick Individual Corporate OfficerSecretary/Treasurer Jun 21, 2021
Mike Schnake Individual Corporate OfficerVice Chair Jun 21, 2021
Rita Gurian Individual Corporate OfficerBoard Member Jun 1, 2022

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 1

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": "1684281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684281600000",
    "number": "1356032643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 E TAMPA ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658061131",
            "telephone_number": "417-831-0150",
            "fax_number": "417-832-8275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 EVERGREEN PKWY",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655364611",
            "telephone_number": "417-334-8337",
            "fax_number": "417-832-8275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATES FOR A HEALTHY COMMUNITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-17",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BROOKS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-851-1551"
    },
    "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": "Jordan Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.