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 - Versailles School

Practice address

913 W Newton St
Versailles, MO 65084-1811

Phone

(660) 851-7770

Fax

(660) 827-8992

NPI assigned

Nov 2, 2012

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 - Versailles School 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 1457605131. Details of each certification follow.

• CCN 791022 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 791022

Legal name

REGIONAL HEALTH CARE CLINIC INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 22, 2021

Last certification

Apr 22, 2021

Ownership / control type

For profit – corporation

Facility address

913 W Newton St
Versailles, MO 65084

Other NPIs on the same Medicare enrollment 2

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

• Regional Health Care Clinic, Inc

  dba Katy Trail - Prairie Hills

  • Federally Qualified Health Center (FQHC)
  • Versailles, MO
  • NPI 1053694422

  O20111201000035

  Same enrollment
• Regional Health Care Clinic, Inc.

  dba Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Stover, MO
  • NPI 1942841903

  O20111201000035

  Same enrollment

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.

• Jessica Arnold, LCSW

  • Clinical Social Worker
  • Sedalia, MO
  • NPI 1285796672
  NPD
• Molly Boston, LCSW

  • Clinical Social Worker
  • Sedalia, MO
  • NPI 1346717469
  NPD
• Keith Edward Segall, DO

  • Family Medicine Physician
  • Warsaw, MO
  • NPI 1639245368
  NPD

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1457605131",
    "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": "913 W NEWTON ST",
            "city": "VERSAILLES",
            "state": "MO",
            "postal_code": "650841811",
            "telephone_number": "660-851-7770",
            "fax_number": "660-827-8992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-02",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Katy Trail - Versailles School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie R Nicholson, FNP-C
• Sharon Louise Patton, PTA
• Quality Industries, Inc.
• Nicole Rea, LIFESTYLE COACH
• Regional Health Care Clinic, Inc (Katy Trail - Prairie Hills)
• Trisha Robinson, LPC
• Angela M. Ross, LCSW
• Frederick Michael Schekorra, DO
• Sharon Lynn Shepherd, ACNS
• Amanda Kay Shipp, M.D.

• Federally Qualified Health Center (FQHC) in Versailles, MO
• Providers in Versailles, 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.