NPIMap

Organization Active NPI

Bates County Memorial Hospital

Doing business as Family Care Clinic High

  • Rural Health Clinic/Center
  • Butler, MO
National Provider Identifier
1609963636
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
268606 Issued in MO
Legal business name
BATES COUNTY MEMORIAL HOSPITAL
Doing business as
Family Care Clinic High
Practice address
615 W Nursery St
Butler, MO 64730-1840
Phone
(660) 200-7000
Fax
(660) 200-7015
NPI assigned
Oct 10, 2006
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BATES COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Mr. Gregory Weaver
Title
Ceo
Phone
(660) 200-7001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 268606 MO Primary

Addresses

Primary practice location

615 W Nursery St
Butler, MO 64730-1840

Mailing address

706 S High St
Butler, MO 64730-1833
Phone (660) 200-2004

Other names 1

  • Family Care Clinic High Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040121000624 MO Part B Supplier - Clinic/Group Practice 8123937356 Receives reassigned benefits from 90 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adrian, MO; Butler, MO; Rich Hill, MO
O20100108000705 MO Part A Provider - Rural Health Clinic 8123937356 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Butler, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609963636. Details of each certification follow.

Rural health clinic certification: CCN 268606

Legal name
BATES COUNTY MEMORIAL HOSPITAL
Doing business as
FAMILY CARE CLINIC NURSERY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 15, 2006
Last certification
Oct 1, 2019
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
617 W Nursery St
Butler, MO 64730-1840
Related CCNs
260034

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Primary Care Specialist

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Gregory a Weaver Individual Corporate DirectorCeo Sep 1, 2020
Operational/Managerial Control Sep 1, 2020
Linda Jennings Individual Corporate Director Oct 23, 2012
Jerry Jones Individual Corporate Director Dec 30, 2009
James Shade Individual Corporate Director Dec 30, 2009
Richard R King Individual Corporate Director Apr 12, 2012

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1609963636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 S HIGH ST",
            "city": "BUTLER",
            "state": "MO",
            "postal_code": "647301833",
            "telephone_number": "660-200-2004",
            "fax_number": "660-200-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 W NURSERY ST",
            "city": "BUTLER",
            "state": "MO",
            "postal_code": "647301840",
            "telephone_number": "660-200-7000",
            "fax_number": "660-200-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BATES COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-200-7001",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "268606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Clinic High",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Clinic High",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Butler, MO

Sources for this page

Verify at the official NPI Registry.