NPIMap

Fordland Clinic, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Springfield, MO

NPI 1386299501 · NPPES record last updated May 26, 2026

Key facts

NPI
1386299501
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
FORDLAND CLINIC, INC.
Practice address
1300 E Bradford Pkwy
Springfield, MO 65804-4264
Phone
(417) 767-2273
NPI assigned
Aug 5, 2019
Organization subpart
Yes
Parent organization (as reported)
FORDLAND CLINIC, INC.

Authorized official

Name
Teri Simmons
Title
Billing/Credentialing Manager
Phone
(417) 767-2273

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 2

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

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 2

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2337782Fordland Clinic Burrell Location
1300 E Bradford Parkway, Building a, Springfield, MO 65804		Certificate of waiverJan 28, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Federally qualified health center certification: CCN 261175

Legal name
FORDLAND CLINIC, INC.
Doing business as
FORDLAND CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 15, 2019
Last certification
Aug 15, 2019
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 9, 1997 in MO
Enrollment address
1300 E Bradford Pkwy
Springfield, MO 65804-4264

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
Paul Farnworth
Individual 		Corporate Officer
Vice President		 Apr 1, 2013
Corporate Director
Board Member		 Jan 1, 2004
Vanessa Owens
Individual 		Corporate Director
Board Member		 Jun 27, 2016
William Gdanitz
Individual 		Corporate Officer
Board President		 Dec 7, 2010
Corporate Director
Board Member		 Oct 1, 2006
Kendra Cunningham
Individual 		Corporate Director Aug 2, 2021
Fordland Clinic, Inc.
Organization · Fordland, MO
Corporation, Non-profit 		Operational/Managerial Control Aug 1, 2015 100%
Delford E Crewse
Individual 		Corporate Officer
Board Treasurer		 Feb 1, 2021
Corporate Director
Board Member		 Jul 11, 2011
Valerie Cochara
Individual 		Corporate Director Jul 12, 2021
Harry Chapin
Individual 		Corporate Director Jul 12, 2021
Joan Twiton
Individual 		Corporate Officer
Ceo		 Jul 3, 2017
W-2 Managing Employee Jan 1, 2002
Operational/Managerial Control
Ceo		 Jul 3, 2017
Michael Dawson
Individual 		Corporate Director Mar 1, 2021
Ray Seiberlich
Individual 		W-2 Managing Employee May 2, 2016
Operational/Managerial Control
Cfo		 May 2, 2016
Linda Kensinger
Individual 		Corporate Officer
Board Secretary		 Jun 5, 2007
Corporate Director
Board Member		 Dec 1, 2006

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fordland Clinic, Inc.
Kimberling City, MO · CCN 261102		 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2012

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20050913000367 MO Part B Supplier - Clinic/Group Practice 5597794552 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fordland, MO; Kimberling City, MO; Springfield, MO
O20190812001523 MO Part a Provider - Federally Qualified Health Center (FQHC) 5597794552 Practice locations: Springfield, MO

National Provider Directory

Tax ID family
Fordland Clinic Inc (3 organizations share this tax ID)
Part of
Fordland Clinic Inc

Specialties & licenses

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

Addresses

Primary practice location

1300 E Bradford Pkwy
Springfield, MO 65804-4264

Mailing address

1059 Barton Dr
Fordland, MO 65652-7350
Phone (417) 767-2273

Other providers in Springfield, MO

All providers in Springfield, MO · Federally Qualified Health Center (FQHC) in Missouri

Sources for this page

Verify at the official NPI Registry.