NPIMap

Organization Active NPI

Mercy Clinic Springfield Communities

Doing business as Mercy Clinic Family Medicine-St. Robert

  • Rural Health Clinic/Center
  • Saint Robert, MO
National Provider Identifier
1770616781
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
Mercy Clinic Family Medicine-St. Robert
Practice address
608 City Route 66
St. Robert, MO 65584
Phone
(573) 336-5100
Fax
(573) 336-3118
NPI assigned
Mar 13, 2007
Last updated
Oct 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
William Roberts
Title
Cfo
Phone
(417) 820-7363

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary
Family Nurse Practitioner 363LF0000X 095237 MO
Family Medicine Physician 207Q00000X 2003017261 MO

Addresses

Primary practice location

608 City Route 66
St. Robert, MO 65584

Mailing address

608 Old Route 66
Saint Robert, MO 65584-3730
Phone (573) 336-5100

Other identifiers 1

IdentifierTypeStateIssuer
593363005MedicaidMO

Other names 1

  • Mercy Clinic Family Medicine-St. Robert Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031218000354 MO Part B Supplier - Clinic/Group Practice 7416865845 Receives reassigned benefits from 1,639 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20040614000920 MO Part A Provider - Rural Health Clinic 7416865845 Practice locations: Saint Robert, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770616781. Details of each certification follow.

Rural health clinic certification: CCN 263813

Legal name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
MERCY CLINIC - ST. ROBERT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 27, 1992
Last certification
Apr 22, 2019
Ownership / control type
2B
Most recent change of ownership
Jul 1, 2004 (2 total)
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2000 in MO
Enrollment address
608 Old Route 66
Saint Robert, MO 65584-3730

Other NPIs on the same Medicare enrollment 29

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

View all 29

National Provider Directory

National Provider Directory
Tax ID family
SPFD CL Cancer and Hema55 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

Locations

645 Maryville Centre Dr
Fl 2
Saint Louis, MO 63141

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Angie J Whitesell Individual Corporate Director Jul 1, 2019
Jessica N Snider Individual Corporate DirectorBoard Member Jul 1, 2018
Jon a Reese Individual Corporate DirectorBoard Member Jul 1, 2021
William Mark Barnett Individual Corporate DirectorBoard Member May 15, 2018
Mark V Griesemer Individual Corporate DirectorBoard Member Jul 1, 2020
Mercy Health Springfield Communities Organization, Springfield, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 1999 100%
Dale E Haverstick Individual Corporate DirectorBoard Member Jul 1, 2021
Christie Eckhardt Individual Corporate OfficerSecretary Jul 1, 2021
Robert B Wyrsch Individual Corporate OfficerPresident Mar 1, 2021
A Daniel Pinheiro Individual Corporate DirectorBoard Member Nov 19, 2019
Stacie Farnam Individual W-2 Managing Employee Jan 1, 2021
Mercy Health Organization, Chesterfield, MO Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 1994 100%
William J Roberts Individual Corporate Director May 20, 2020
W-2 Managing Employee May 20, 2020
Dustin R Tompkins Individual Corporate DirectorBoard Member Jul 1, 2020
Mark J Van Ess Individual Corporate OfficerVice Chair Jul 1, 2020
Barbara a Bumberry Individual Corporate DirectorBoard Member Jul 1, 2020
Bala Sudhakar Reddy Allam Individual Corporate DirectorBoard Member Jul 1, 2018
David G Argueta Individual Corporate OfficerPresident Jun 1, 2022
Jason a Glenn Individual Corporate DirectorBoard Member Jul 1, 2022

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 115

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 115

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1770616781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 OLD ROUTE 66",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655843730",
            "telephone_number": "573-336-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 CITY ROUTE 66",
            "city": "ST. ROBERT",
            "state": "MO",
            "postal_code": "65584",
            "telephone_number": "573-336-5100",
            "fax_number": "573-336-3118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-820-7363"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "095237",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2003017261",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "593363005",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic Family Medicine-St. Robert",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic Family Medicine-St. Robert",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Robert, MO

Sources for this page

Verify at the official NPI Registry.