NPIMap

Organization Active NPI

Family Counseling Center, Inc.

Doing business as FCC Primary Care Clinic

  • Rural Health Clinic/Center
  • Kennett, MO
National Provider Identifier
1386101467
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY COUNSELING CENTER, INC.
Doing business as
FCC Primary Care Clinic
Practice address
900 State Route VV
Kennett, MO 63857-3834
Phone
(573) 888-5925
NPI assigned
Feb 26, 2019
Last updated
Aug 19, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
FAMILY COUNSELING CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Authorized official

Name
Mary Shane Guthrie
Title
Privileging Coordinator
Phone
(573) 888-5925

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

900 State Route VV
Kennett, MO 63857-3834

Mailing address

PO Box 71
Kennett, MO 63857-0071

Other names 1

  • FCC Primary Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609001127 MO Part B Supplier - Clinic/Group Practice 2163410481 Receives reassigned benefits from 77 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Campbell, MO; West Plains, MO; Wappapello, MO; Van Buren, MO; Poplar Bluff, MO; Piedmont, MO; Mountain Grove, MO; Malden, MO…

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Family Counseling Cente

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2021 Change of OwnershipThis provider was the seller FCC Primary Care ClinicCCN 793851, MO, NPI 1043885254

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

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": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1386101467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638570071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 STATE ROUTE VV",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573834",
            "telephone_number": "573-888-5925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY COUNSELING CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY COUNSELING CENTER, INC.",
        "enumeration_date": "2019-02-26",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "GUTHRIE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PRIVILEGING COORDINATOR",
        "authorized_official_telephone_number": "573-888-5925"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCC Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FCC Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennett, MO

Sources for this page

Verify at the official NPI Registry.