NPIMap

Regional Health Care Clinic, Inc.

Organization Active NPI Federally Qualified Health Center (FQHC) · Sedalia, MO

NPI 1700532306 · NPPES record last updated Feb 21, 2024

Key facts

NPI
1700532306
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
REGIONAL HEALTH CARE CLINIC, INC.
Practice address
305 W Main St
Sedalia, MO 65301-3821
Phone
(660) 310-0909
NPI assigned
Feb 23, 2022
Organization subpart
No

Authorized official

Name
Michael Waller
Title
Ceo
Phone
(660) 826-4774

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 17

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

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Federally qualified health center certification: CCN 261904

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
Apr 25, 2022
Last certification
Apr 25, 2022
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Nov 3, 1999 in MO
Enrollment address
305 W Main St
Sedalia, MO 65301-3821

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 Officer
Vice President, Board of Directors		 Mar 1, 2008
Corporate Director
Board Member		 Mar 1, 2008
Linda Messenger
Individual 		Corporate Officer
Secretary, Board of Directors		 Mar 1, 2002
Michelle Hendricks
Individual 		Corporate Officer
Cfo		 Jan 1, 2024
Michael Waller
Individual 		Corporate Officer
Ceo		 Jan 1, 2024
W-2 Managing Employee
Ceo		 Jan 1, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040304001212 MO Part B Supplier - Clinic/Group Practice 8224926092 Receives reassigned benefits from 57 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cole Camp, MO; Green Ridge, MO; Marshall, MO; Sedalia, MO; Warsaw, MO
O20220425000234 MO Part a Provider - Federally Qualified Health Center (FQHC) 8224926092 Practice locations: Sedalia, MO

National Provider Directory

Tax ID family
Community Free Clinic I (18 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

305 W Main St
Sedalia, MO 65301-3821

Mailing address

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

Other names

  • Katy Trail Community Health Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 21, 2024.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1700532306",
    "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": "305 W MAIN ST",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653013821",
            "telephone_number": "660-310-0909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "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": "660-826-4774"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Community Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Katy Trail Community Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sedalia, MO

All providers in Sedalia, MO · Federally Qualified Health Center (FQHC) in Missouri

Sources for this page

Verify at the official NPI Registry.