NPIMap

Organization Active NPI

Advocates for a Healthy Community, Inc.

Doing business as Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
National Provider Identifier
1366575573
Registry record updated Jan 27, 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
1720 W Grand St
Springfield, MO 65802-4802
Phone
(417) 831-0150
NPI assigned
Mar 14, 2007
Last updated
Jan 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Authorized official

Name
Kenneth Brooks Miller Jr.
Title
Ceo
Phone
(417) 831-0150

Specialties & licenses 1

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

Addresses

Primary practice location

1720 W Grand St
Springfield, MO 65802-4802

Mailing address

440 E Tampa St
Springfield, MO 65806-1131
Phone (417) 851-1551

Other identifiers 1

IdentifierTypeStateIssuer
506018308MedicaidMO

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
O20230131003126 MO Part A Provider - Federally Qualified Health Center (FQHC) 5395653562 Practice locations: Springfield, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366575573. Details of each certification follow.

Federally qualified health center certification: CCN 261928

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
Jan 30, 2023
Last certification
Jan 30, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 21, 1992 in MO
Enrollment address
1720 W Grand St
Springfield, MO 65802-4802

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
Advocates for a Healthy 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

Locations

1720 W Grand St
Ste B
Springfield, MO 65802
Phone (417) 851-1625

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 DirectorBoard Member Jun 1, 2021
Jeff Davis Individual Corporate DirectorDirector Jun 1, 2021
Yadira Howe Individual W-2 Managing EmployeeExecutive Vice President, Adm Mar 20, 2024
Kenneth B Miller Individual Corporate DirectorCeo Aug 12, 2002
Christy Wilson Individual W-2 Managing EmployeeDirector, Revenue Cycle Mar 20, 2024
Mendie Schoeller Individual Corporate DirectorBoard Member Jun 16, 2019
Matthew Stinson Individual Corporate OfficerCeo Jun 1, 2024
Trey Peck Individual Corporate DirectorBoard Member Jun 1, 2021
Kevin Gipson Individual Corporate DirectorBoard Member Jun 1, 2021
John Twitty Individual Corporate OfficerChair Jun 1, 2011
Phil Brown Individual Corporate OfficerBoard Member Jun 1, 2022
Richard Hardy Individual Corporate DirectorBoard Member Jul 5, 2019
Carol Dehaven Janick Individual Corporate OfficerSecretary/Treasurer Nov 20, 2017
Mike Schnake Individual Corporate OfficerVice Chair Jun 19, 2001
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 53

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 53

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1366575573",
    "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": "417-851-1551",
            "fax_number": "417-831-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 W GRAND ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658024802",
            "telephone_number": "417-831-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATES FOR A HEALTHY COMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "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": "417-831-0150",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506018308",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jordan Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.