Ozark Tri County Health Care Consortium

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

OZARK TRI COUNTY HEALTH CARE CONSORTIUM

Practice address

530 S Maiden LN
Joplin, MO 64801-3084

Phone

(417) 782-0080

Fax

(417) 782-0096

NPI assigned

Jun 5, 2006

Organization subpart

Yes

Parent organization

OZARK TRI-COUNTY HEALTH CARE CONSORTIUMAs reported in NPPES

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

Authorized official

Name

Don M McBride

Title

Ceo

Phone

(417) 451-9450

Specialties & licenses 1

Addresses

Other names 1

• ACCESS Family Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Federally qualified health center certification: CCN 261873

Legal name

OZARK TRI-COUNTY HEALTH CARE CONSORTIUM

Doing business as

ACCESS FAMILY CARE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 8, 2004

Last certification

Apr 8, 2004

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 19, 1996 in MO

Enrollment address

530 S Maiden LN
Joplin, MO 64801-3084

Other NPIs on the same Medicare enrollment 1

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

• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1538151733

  O20040319001108

  Same enrollment

Part of

Ozark Tri-County Consortium

All disclosed owners & managing parties 21

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

Owners & managing parties with NPI records 3

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

• Charles Henry Bentlage, MD

  • Family Medicine Physician
  • Neosho, MO
  • NPI 1033436902

  Corporate Director

  CMS ownership
• John Derick Paulson, DO

  • Family Medicine Physician
  • Joplin, MO
  • NPI 1801077797

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Kala Smith

  • Dentist
  • Joplin, MO
  • NPI 1558687871

  Corporate Officer, W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1376582346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "address_2": "475 NELSON AVENUE",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648500758",
            "telephone_number": "417-451-9450",
            "fax_number": "417-451-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S MAIDEN LN",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648013084",
            "telephone_number": "417-782-0080",
            "fax_number": "417-782-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OZARK TRI COUNTY HEALTH CARE CONSORTIUM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OZARK TRI-COUNTY HEALTH CARE CONSORTIUM",
        "enumeration_date": "2006-06-05",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "MCBRIDE",
        "authorized_official_first_name": "DON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-451-9450"
    },
    "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": "ACCESS Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ozark Center
• Ozark Center - DD Outpatient
• Ozark Compounding Pharmacy
• Ozark Family Dental, LLC
• Ozark Gastroenterology, Inc
• Ozark Tri-County Health Care Consortium
• Ozark Tri-County Health Care Consortium
• Ozark Tri-County Health Care Consortium
• Ozark Tri-County Health Care Consortium
• Ozark Tri-County Health Care Consortium

• All providers in Joplin, MO
• Federally Qualified Health Center (FQHC) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.