NPIMap

Organization Active NPI

Mercy Clinic Springfield Communities

Doing business as Mercy Clinic Family Medicine-Salem

  • Rural Health Clinic/Center
  • Salem, MO
National Provider Identifier
1497886451
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
Mercy Clinic Family Medicine-Salem
Practice address
404 W Rolla Rd
Salem, MO 65560
Phone
(573) 729-6225
Fax
(573) 729-7258
NPI assigned
Mar 8, 2007
Last updated
Oct 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

Name
William J Roberts
Title
Cfo
Phone
(417) 820-7363

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 113166 MO
Rural Health Clinic/Center 261QR1300X MO Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 054413 MO

Addresses

Primary practice location

404 W Rolla Rd
Salem, MO 65560

Mailing address

404 W Rolla Rd
Salem, MO 65560-1233
Phone (417) 820-7133

Other identifiers 1

IdentifierTypeStateIssuer
593362908MedicaidMO

Other names 1

  • Mercy Clinic Family Medicine-Salem Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000354 MO Part B Supplier - Clinic/Group Practice 7416865845 Receives reassigned benefits from 1,639 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20101116001005 MO Part A Provider - Rural Health Clinic 7416865845 Practice locations: Salem, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497886451. Details of each certification follow.

Rural health clinic certification: CCN 263870

Legal name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
MERCY CLINIC -SALEM
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 3, 1997
Last certification
Apr 14, 2021
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2004 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2000 in MO
Enrollment address
404W Rolla Rd
Salem, MO 65560-1233

Other NPIs on the same Medicare enrollment 29

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

View all 29

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
26D0665227Mercy Clinic Salem404 West Rolla Road, Salem, MO 65560Certificate of waiverMar 12, 2027

National Provider Directory

National Provider Directory

Locations

448 State Highway 248
Ste 160
Branson, MO 65616
Phone (417) 213-4696

404 W Rolla Rd
Salem, MO 65560
Phone (573) 729-6225

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Angie J Whitesell Individual Corporate Director Jul 1, 2019
Jessica N Snider Individual Corporate DirectorBoard Member Jul 1, 2018
Jon a Reese Individual Corporate DirectorBoard Member Jul 1, 2021
William Mark Barnett Individual Corporate DirectorBoard Member Jul 1, 2018
Mark V Griesemer Individual Corporate DirectorBoard Member Jul 1, 2020
Cheryl L Matejka Individual Operational/Managerial ControlSVP-Cfo Jul 1, 2021
Mercy Health Springfield Communities Organization, Springfield, MO Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 2012 100%
Dale E Haverstick Individual Corporate DirectorBoard Member Jul 1, 2021
Christie Eckhardt Individual Corporate OfficerSecretary Jul 1, 2021
Robert B Wyrsch Individual Corporate OfficerPresident Mar 1, 2021
A Daniel Pinheiro Individual Corporate DirectorBoard Member Nov 19, 2019
Stacie Farnam Individual W-2 Managing Employee Jan 1, 2021
Mercy Health Organization, Chesterfield, MO Non-profit 5% Or Greater Indirect Ownership Interest Oct 2, 2010 100%
William J Roberts Individual Corporate Director May 20, 2020
W-2 Managing Employee May 20, 2020
Dustin R Tompkins Individual Corporate DirectorBoard Member Jul 1, 2020
Mark J Van Ess Individual Corporate OfficerVice Chair Jul 1, 2020
Barbara a Bumberry Individual Corporate DirectorBoard Member Jul 1, 2020
Bala Sudhakar Reddy Allam Individual Corporate DirectorBoard Member Jul 1, 2018
David G Argueta Individual Corporate OfficerPresident Jun 1, 2022
Jason a Glenn Individual Corporate DirectorBoard Member Jul 1, 2022

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 115

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

View all 115

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1497886451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W ROLLA RD",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "655601233",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W ROLLA RD",
            "city": "SALEM",
            "state": "MO",
            "postal_code": "65560",
            "telephone_number": "573-729-6225",
            "fax_number": "573-729-7258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-820-7363"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "113166",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "054413",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "593362908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic Family Medicine-Salem",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic Family Medicine-Salem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salem, MO

Sources for this page

Verify at the official NPI Registry.