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Organization Active NPI

Burton Creek Rural Clinic, LLC

  • Rural Health Clinic/Center
  • West Plains, MO
National Provider Identifier
1720075161
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BURTON CREEK RURAL CLINIC, LLC
Practice address
805 Kentucky Ave
West Plains, MO 65775
Phone
(417) 256-2111
Fax
(417) 256-4858
NPI assigned
Sep 30, 2005
Last updated
Feb 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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

Authorized official

Name
Mr. Theresa Christine Gregg, MHA
Title
Administrator
Phone
(417) 256-2111

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

805 Kentucky Ave
West Plains, MO 65775

Mailing address

805 N Kentucky Ave
West Plains, MO 65775-2022
Phone (417) 256-2111

Other identifiers 3

IdentifierTypeStateIssuer
509022307MedicaidMO
DC9179OtherMEDICARE RR
599022308MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031023000025 MO Part A Provider - Rural Health Clinic 4587576244 Practice locations: West Plains, MO
O20050108000031 MO Part B Supplier - Clinic/Group Practice 4587576244 Receives reassigned benefits from 18 practitioners
Practice locations: West Plains, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720075161. Details of each certification follow.

Rural health clinic certification: CCN 268904

Legal name
BURTON CREEK RURAL CLINIC LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 8, 2004
Last certification
Apr 13, 2021
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Jul 16, 2003 in MO
Enrollment address
805 N Kentucky Ave
West Plains, MO 65775-2022

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jeffrey F Roylance Individual 5% Or Greater Direct Ownership InterestOwner Jun 23, 2006 16.66%
Leslie E Barr Individual 5% Or Greater Direct Ownership InterestOwner Jul 1, 2011 16.66%
Aaron L Mills Individual 5% Or Greater Direct Ownership InterestPresident/Owner Dec 1, 2008 16.66%
Robert a Martin Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2003 16.66%
Tyler Thompson Individual Corporate DirectorAdministrator Dec 19, 2022
W-2 Managing EmployeeAdministrator Dec 19, 2022
Operational/Managerial ControlAdministrator Dec 19, 2022
Derek J Morrison Individual 5% Or Greater Direct Ownership InterestOwner Oct 1, 2022 16.66%
Charles Nathaniel Swift Individual 5% Or Greater Direct Ownership Interest Aug 1, 2015

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1720075161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752022",
            "telephone_number": "417-256-2111",
            "fax_number": "417-256-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "65775",
            "telephone_number": "417-256-2111",
            "fax_number": "417-256-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURTON CREEK RURAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "GREGG",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "417-256-2111",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "509022307",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "DC9179",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "599022308",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Plains, MO

Sources for this page

Verify at the official NPI Registry.