NPIMap

Organization Active NPI

Cheryl G Williams DO PC

Doing business as Mt.Vernon Clinic

  • Rural Health Clinic/Center
  • Mount Vernon, MO
National Provider Identifier
1649332156
Registry record updated Jan 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
113916 Issued in MO
Legal business name
CHERYL G WILLIAMS DO PC
Doing business as
Mt.Vernon Clinic
Practice address
1011 S East St
Mount Vernon, MO 65712-1331
Phone
(417) 466-7191
Fax
(417) 466-3876
NPI assigned
Dec 14, 2006
Last updated
Jan 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2026

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

Authorized official

Name
Mr. Robert Williams
Title
Office Manager
Phone
(417) 466-7191

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X 113916 MO Primary

Addresses

Primary practice location

1011 S East St
Mount Vernon, MO 65712-1331

Mailing address

1011 S East St
Mount Vernon, MO 65712-1399
Phone (417) 466-7191

Other identifiers 1

IdentifierTypeStateIssuer
590665907MedicaidMO

Other names 1

  • Mt.Vernon Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050215001046 MO Part B Supplier - Clinic/Group Practice 1951353192 Receives reassigned benefits from 4 practitioners
Practice locations: Aurora, MO; Mt Vernon, MO; Monett, MO; Mount Vernon, MO
O20050830000585 MO Part A Provider - Rural Health Clinic 1951353192 Practice locations: Mount Vernon, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649332156. Details of each certification follow.

Rural health clinic certification: CCN 268946

Legal name
CHERYL G WILLIAMS DO PC
Doing business as
MT. VERNON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 14, 2005
Last certification
Dec 11, 2018
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Apr 12, 2002 in MO
Enrollment address
1011 S East St
Mount Vernon, MO 65712-1331

National Provider Directory

National Provider Directory

Locations

1700 S Hudson Ave
Aurora, MO 65605
Phone (417) 678-2165

1011 S East St
Mount Vernon, MO 65712
Phone (417) 466-7191

1011 S East St
#I44
Mount Vernon, MO 65712

1425 S Landrum St
Mount Vernon, MO 65712
Phone (417) 466-2260

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Cheryl L Williams Individual Contracted Managing EmployeeOwner Jul 1, 2022 100%
5% Or Greater Direct Ownership Interest Jul 1, 2002 100%
W-2 Managing Employee Jul 1, 2000

Owners & managing parties with NPI records 1

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

  • Cheryl G Williams, D.O.
    • Family Medicine Physician
    • Mount Vernon, MO
    • NPI 1730187204

    5% Or Greater Direct Ownership Interest, Contracted Managing Employee, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 8

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": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1649332156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 S EAST ST",
            "city": "MOUNT VERNON",
            "state": "MO",
            "postal_code": "657121399",
            "telephone_number": "417-466-7191",
            "fax_number": "417-466-3876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 S EAST ST",
            "city": "MOUNT VERNON",
            "state": "MO",
            "postal_code": "657121331",
            "telephone_number": "417-466-7191",
            "fax_number": "417-466-3876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERYL G WILLIAMS DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "417-466-7191",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "113916",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590665907",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt.Vernon Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, MO

Sources for this page

Verify at the official NPI Registry.