NPIMap

Organization Active NPI

Regional Health Care Clinic, Inc

Doing business as Katy Trail - Warsaw School

  • Federally Qualified Health Center (FQHC)
  • Warsaw, MO
National Provider Identifier
1629797196
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGIONAL HEALTH CARE CLINIC, INC
Doing business as
Katy Trail - Warsaw School
Practice address
20363 Lane of Champions
Warsaw, MO 65355-6463
Phone
(660) 438-7120
Fax
(888) 979-8868
NPI assigned
Aug 26, 2022
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Michael Waller
Title
Ceo
Phone
(660) 438-7120

Specialties & licenses 1

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

Addresses

Primary practice location

20363 Lane of Champions
Warsaw, MO 65355-6463

Mailing address

821 Westwood Dr
Sedalia, MO 65301-2102
Phone (660) 826-4774

Other names 1

  • Katy Trail - Warsaw School Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221118000803 MO Part A Provider - Federally Qualified Health Center (FQHC) 8224926092 Practice locations: Warsaw, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629797196. Details of each certification follow.

Federally qualified health center certification: CCN 261917

Legal name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
KATY TRAIL COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 17, 2022
Last certification
Nov 17, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 1999 in MO
Enrollment address
20363 Lane of Champions
Warsaw, MO 65355-6463

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Regional Health Care Clinic18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

313 E Eastwood St
Marshall, MO 65340
Phone (660) 886-7100

1700 E Broadway Blvd
Sedalia, MO 65301

305 W Main St
Sedalia, MO 65301
Phone (660) 310-0909

112 N State Highway 5
Versailles, MO 65084
Phone (573) 378-2349

519 E Jefferson St
Warsaw, MO 65355
Phone (660) 438-2717

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Angela Saran Individual Corporate OfficerVice President, Board of Directors Mar 1, 2008
Corporate DirectorBoard Member Mar 1, 2008
Michelle Hendricks Individual Corporate OfficerCfo Jan 1, 2024
Michael Waller Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
Darren Grove Individual Corporate OfficerSecretary, Board of Directors Aug 26, 2022

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1629797196",
    "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": "888-979-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20363 LANE OF CHAMPIONS",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653556463",
            "telephone_number": "660-438-7120",
            "fax_number": "888-979-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-26",
        "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": "660-438-7120"
    },
    "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 - Warsaw School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warsaw, MO

Sources for this page

Verify at the official NPI Registry.