Regional Health Care Clinic, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

REGIONAL HEALTH CARE CLINIC, INC.

Doing business as

Katy Trail - Green Ridge R-VIII

Practice address

401 W Pettis St
Green Ridge, MO 65332-1160

Phone

(877) 733-5824

Fax

(888) 979-8868

NPI assigned

Oct 10, 2019

Last updated

Feb 21, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Waller

Title

Ceo

Phone

(877) 733-5824

Specialties & licenses 1

Addresses

Other names 1

• Katy Trail - Green Ridge R-VIII Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417599556. Details of each certification follow.

• CCN 261198 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 261198

Legal name

KATY TRAIL COMMUNITY HEALTH

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 31, 2020

Last certification

Mar 31, 2020

Ownership / control type

For profit – corporation

Facility address

401 West Pettis Street
Green Ridge, MO 65332

Other NPIs on the same Medicare enrollment 5

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

• Regional Health Care Clinic Inc

  dba Katy Trail Community Health Warsaw

  • Federally Qualified Health Center (FQHC)
  • Warsaw, MO
  • NPI 1053533539

  O20040304001212

  Same enrollment
• Regional Health Care Clinic Inc

  dba Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Sedalia, MO
  • NPI 1922057504

  O20040304001212

  Same enrollment
• Regional Health Care Clinic, Inc

  dba Katy Trail Community Health Cole Camp R-1

  • Federally Qualified Health Center (FQHC)
  • Cole Camp, MO
  • NPI 1285288472

  O20040304001212

  Same enrollment
• Regional Health Care Clinic, Inc

  dba Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Marshall, MO
  • NPI 1972981942

  O20040304001212

  Same enrollment
• Regional Health Care Clinic, Inc.

  dba Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Sedalia, MO
  • NPI 1700532306

  O20040304001212

  Same enrollment

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1417599556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WESTWOOD DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012102",
            "telephone_number": "660-826-4774",
            "fax_number": "660-826-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W PETTIS ST",
            "city": "GREEN RIDGE",
            "state": "MO",
            "postal_code": "653321160",
            "telephone_number": "877-733-5824",
            "fax_number": "888-979-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-733-5824"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katy Trail - Green Ridge R-VIII",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Claressa Kay Chamberln
• Green Ridge R-VIII School District
• Angela Hagedorn, MS-CCC-SLP
• Coby Thrailkill
• Yes Therapy LLC

• Federally Qualified Health Center (FQHC) in Green Ridge, MO
• Providers in Green Ridge, MO by specialty
• Federally Qualified Health Center (FQHC) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.