NPIMap

Organization Active NPI

Compass Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sullivan, MO
National Provider Identifier
1730625104
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMPASS HEALTH, INC.
Practice address
101 Progress Pkwy
Sullivan, MO 63080-2359
Phone
(660) 890-8186
NPI assigned
Jan 10, 2017
Last updated
Jan 10, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Authorized official

Name
Teresa Porter
Title
Credentialing/Contracting Manager
Phone
(660) 890-8186

Specialties & licenses 1

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

Addresses

Primary practice location

101 Progress Pkwy
Sullivan, MO 63080-2359

Mailing address

1800 Community
Clinton, MO 64735-8804
Phone (660) 890-8186

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170316001427 MO Part A Provider - Federally Qualified Health Center (FQHC) 1951206754 Practice locations: Sullivan, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730625104. Details of each certification follow.

Federally qualified health center certification: CCN 261134

Legal name
COMPASS HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2017
Last certification
Mar 16, 2017
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 3, 2004 in MO
Enrollment address
101 Progress Pkwy
Sullivan, MO 63080-2359

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2333834Compass Health - Sullivan101 Progress Pkwy, Sullivan, MO 63080Certificate of waiverNov 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pathways Community Behavioral Healthcare Inc127 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Joi Niedner Individual Corporate OfficerBoard Member Jan 1, 2023
Dennis Daugherty Individual Corporate OfficerBoard Member Jan 1, 2023
Rebecca Culler Individual Corporate OfficerBoard Member Jan 1, 2023
Jacob Krafve Individual Corporate OfficerCfo Feb 17, 2017 100%
Rodney Reid Individual Corporate OfficerBoard Member Jan 1, 2023
Teresa L Porter Individual W-2 Managing EmployeeCredentialing Manager Feb 27, 2017
Curtis Cain Individual Corporate OfficerBoard Member Jan 1, 2023
Tim Glasscock Individual Corporate OfficerBoard Member Jan 1, 2023
Patricia Cleveland Individual Corporate OfficerBoard Member Jan 1, 2023
Brian C Baker Individual Corporate OfficerBoard Member Jan 1, 2023
Tim Alan Larimore Individual Corporate OfficerBoard Member Jan 1, 2023
Timothy Swinfard Individual Corporate OfficerCeo Feb 27, 2017 100%
Corporate DirectorCeo Feb 27, 2017 100%
Alan W Stevens Individual Corporate DirectorExecutive VP Jan 1, 2023

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Compass Health IncSaint Peters, MO, CCN 261161 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 11, 2018

NPI Registry JSON

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484006400000",
    "number": "1730625104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-890-8186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROGRESS PKWY",
            "city": "SULLIVAN",
            "state": "MO",
            "postal_code": "630802359",
            "telephone_number": "660-890-8186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPASS HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-10",
        "last_updated": "2017-01-10",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CREDENTIALING/CONTRACTING MANAGER",
        "authorized_official_telephone_number": "660-890-8186"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, MO

Sources for this page

Verify at the official NPI Registry.