NPIMap

Organization Active NPI

Fordland Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
National Provider Identifier
1386299501
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FORDLAND CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Authorized official

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

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386299501. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 9, 1997 in MO
Enrollment address
1300 E Bradford Pkwy
Springfield, MO 65804-4264

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2337782Fordland Clinic Burrell Location1300 E Bradford Parkway, Building a, Springfield, MO 65804Certificate of waiverJan 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Fordland Clinic Inc3 organizations share this tax ID, including this one
Part of
Fordland Clinic Inc

Other organizations with this tax ID 2

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

Locations

1059 Barton Dr
Fordland, MO 65652
Phone (417) 767-2100

Ownership & related parties

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 OfficerVice President Apr 1, 2013
Corporate DirectorBoard Member Jan 1, 2004
Vanessa Owens Individual Corporate DirectorBoard Member Jun 27, 2016
William Gdanitz Individual Corporate OfficerBoard President Dec 7, 2010
Corporate DirectorBoard 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 OfficerBoard Treasurer Feb 1, 2021
Corporate DirectorBoard Member Jul 11, 2011
Valerie Cochara Individual Corporate Director Jul 12, 2021
Harry Chapin Individual Corporate Director Jul 12, 2021
Joan Twiton Individual Corporate OfficerCeo Jul 3, 2017
W-2 Managing Employee Jan 1, 2002
Operational/Managerial ControlCeo Jul 3, 2017
Michael Dawson Individual Corporate Director Mar 1, 2021
Ray Seiberlich Individual W-2 Managing Employee May 2, 2016
Operational/Managerial ControlCfo May 2, 2016
Linda Kensinger Individual Corporate OfficerBoard Secretary Jun 5, 2007
Corporate DirectorBoard Member Dec 1, 2006

Owners & managing parties with NPI records 2

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

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

Owned or controlled facilities with NPI records 1

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

  • Fordland Clinic, Inc.

    dba Tri-Lakes Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Kimberling City, MO
    • NPI 1639421365

    Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

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

  • Fordland Clinic, Inc.

    dba Tri-Lakes Community Health Center

    • Federally Qualified Health Center (FQHC)
    • Kimberling City, MO
    • NPI 1639421365

    Fordland Clinic, Inc.

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1564963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1386299501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 BARTON DR",
            "city": "FORDLAND",
            "state": "MO",
            "postal_code": "656527350",
            "telephone_number": "417-767-2273",
            "fax_number": "417-767-4054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044264",
            "telephone_number": "417-767-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDLAND CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FORDLAND CLINIC, INC.",
        "enumeration_date": "2019-08-05",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "417-767-2273"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.