NPIMap

Organization Active NPI

Mercy Clinic Springfield Communities

  • Rural Health Clinic/Center
  • Birch Tree, MO
National Provider Identifier
1811065477
Registry record updated Oct 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Practice address
9138 O'Banion St
Birch Tree, MO 65438
Phone
(573) 292-3213
Fax
(573) 292-4442
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2025

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X R7838 MO
Rural Health Clinic/Center 261QR1300X MO Primary

Addresses

Primary practice location

9138 O'Banion St
Birch Tree, MO 65438

Mailing address

9138 Obanion St
Birch Tree, MO 65438-8485
Phone (417) 820-7133

Other identifiers 1

IdentifierTypeStateIssuer
592365407MedicaidMO

Other names 1

  • Mercy Clinic Family Medicine-Birch Tree 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
O20100219000232 MO Part A Provider - Rural Health Clinic 7416865845 Practice locations: Birch Tree, MO

Rural health clinic certification: CCN 263806

Legal name
MERCY CLINIC SPRINGFIELD COMMUNITIES
Doing business as
MERCY CLINIC - BIRCH TREE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 3, 1992
Last certification
Apr 14, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2000 in MO
Enrollment address
9138 Obanion St
Birch Tree, MO 65438-8485

Other NPIs on the same Medicare enrollment 29

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

View all 29

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
26D0446877Mercy Clinic Family Medicince Birch Tree9138 O'Banion Street, Birch Tree, MO 65438Certificate of waiverFeb 6, 2028

National Provider Directory

National Provider Directory

Locations

9138 Obanion St
Birch Tree, MO 65438
Phone (573) 292-3213

Ownership & related parties

All disclosed owners & managing parties 20

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 DirectorChairperson Jul 1, 2021
Jon a Reese Individual Corporate DirectorBoard Member Jul 1, 2021
William Mark Barnett Individual Corporate Director May 15, 2018
Mark V Griesemer Individual Corporate DirectorBoard Member Jul 1, 2020
Cheryl L Matejka Individual Operational/Managerial ControlSVP-Cfo Jul 1, 2021
Mercy Health Springfield Communities Organization, Springfield, MO Corporation 5% Or Greater Direct Ownership Interest Sep 1, 1993 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 Corporation 5% Or Greater Indirect Ownership Interest Sep 1, 1993 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 DirectorVise Chairman Jul 1, 2021
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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760400000000",
    "number": "1811065477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9138 OBANION ST",
            "city": "BIRCH TREE",
            "state": "MO",
            "postal_code": "654388485",
            "telephone_number": "417-820-7133",
            "fax_number": "417-820-0586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9138 O'BANION ST",
            "city": "BIRCH TREE",
            "state": "MO",
            "postal_code": "65438",
            "telephone_number": "573-292-3213",
            "fax_number": "573-292-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY CLINIC SPRINGFIELD COMMUNITIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2025-10-14",
        "certification_date": "2025-10-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "417-820-7363"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R7838",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "592365407",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic Family Medicine-Birch Tree",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Clinic Family Medicine-Birch Tree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Birch Tree, MO

Sources for this page

Verify at the official NPI Registry.