NPIMap

Organization Active NPI

Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • New Madrid, MO
National Provider Identifier
1609095975
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST MISSOURI HEALTH NETWORK
Practice address
655 Highway 61
New Madrid, MO 63869-1733
Phone
(573) 748-2592
Fax
(573) 748-2673
NPI assigned
Apr 25, 2007
Last updated
Dec 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Authorized official

Name
Sara Deane
Title
Chief Financial Officer
Phone
(573) 313-2500

Specialties & licenses 1

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

Addresses

Primary practice location

655 Highway 61
New Madrid, MO 63869-1733

Mailing address

6738 State Highway 77
Benton, MO 63736-8238
Phone (573) 313-2500

Other names 1

  • New Madrid Medical Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050412000011 MO Part B Supplier - Clinic/Group Practice 6507818044 Receives reassigned benefits from 20 practitioners
9 other NPIs on this enrollment
Practice locations: Caruthersville, MO; Sikeston, MO; New Madrid, MO; Kennett, MO; Bernie, MO; Benton, MO
O20100624000145 MO Part A Provider - Federally Qualified Health Center (FQHC) 6507818044 Practice locations: New Madrid, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609095975. Details of each certification follow.

Federally qualified health center certification: CCN 261825

Legal name
SOUTHEAST MISSOURI HEALTH NETWORK
Doing business as
NEW MADRID MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1992
Last certification
Oct 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
May 1, 1999 in MO
Enrollment address
655 US Highway 61
New Madrid, MO 63869-1733

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Southeast Missouri Network14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

420 Semo Dr
New Madrid, MO 63869

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
Lance Crawford Individual Corporate DirectorMember, Board of Directors Nov 29, 1980
Vickie Gillespie Individual Corporate DirectorMember, Board of Directors Sep 29, 2007
David Howard Individual Corporate DirectorMember, Board of Directors Nov 17, 2014
Scott Lawrence Individual Corporate OfficerChief Operations Officer Jan 15, 2019
Mary Davis Individual Corporate DirectorMember, Board of Directors Aug 20, 2007
George B McVay Individual Corporate DirectorMember, Board of Directors Nov 24, 2014
Christopher Jones Individual Corporate OfficerChief Executive Officer Dec 10, 2013
Teresa Richey Individual Corporate OfficerDirector of Nursing Jan 25, 2010
Terunda L Farr Individual W-2 Managing EmployeeBilling Supervisor Dec 4, 2014
Catherine Bockhold Individual Corporate DirectorMember, Board of Directors Mar 1, 2011
Cynthia Sharp-Amick Individual Corporate DirectorMember, Board of Directors Mar 17, 2014
Sara Deane Individual Corporate OfficerChief Financial Officer Dec 8, 2014

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Sikeston Alternative Education Center ClinicSikeston, MO, CCN 261181 Federally qualified health center Operational/Managerial Control Nov 4, 2019
NMCC School Based Health CenterNew Madrid, MO, CCN 261989 Federally qualified health center Operational/Managerial Control Nov 4, 2019

Owned or controlled facilities with NPI records 2

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

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": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733961600000",
    "number": "1609095975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 HIGHWAY 61",
            "city": "NEW MADRID",
            "state": "MO",
            "postal_code": "638691733",
            "telephone_number": "573-748-2592",
            "fax_number": "573-748-2673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "DEANE",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "573-313-2500"
    },
    "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": "New Madrid Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New Madrid, MO

Sources for this page

Verify at the official NPI Registry.