NPIMap

Organization Active NPI

Cape Girardeau County Health Department

  • Rural Health Clinic/Center
  • Cape Girardeau, MO
National Provider Identifier
1831174762
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT
Practice address
1121 Linden St
Lower Level
Cape Girardeau, MO 63703-7708
Phone
(573) 335-2229
Fax
(573) 339-8768
NPI assigned
Dec 14, 2005
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CAPE GIRARDEAU COUNTY HEALTH DEPARTMENTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Peggy Jane Wernsman, RN
Title
Director
Phone
(573) 335-7846

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1121 Linden St
Lower Level
Cape Girardeau, MO 63703-7708

Mailing address

PO Box 1839
Cape Girardeau, MO 63702-1839
Phone (573) 335-2229

Other identifiers 2

IdentifierTypeStateIssuer
508534906MedicaidMO
598534907MedicaidMO

Other names 1

  • CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101112000976 MO Part A Provider - Rural Health Clinic 6406935808 Practice locations: Cape Girardeau, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831174762. Details of each certification follow.

Rural health clinic certification: CCN 263862

Legal name
CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT
Doing business as
CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 24, 1996
Last certification
May 17, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1121 Linden Street
Cape Girardeau, MO 63703-7708

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Cape Girardeau County P2 organizations share this tax ID, including this one
Part of
Cape Girardeau County P

Other organizations with this tax ID 1

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

Locations

1121 Linden St
Cpe Girardeau, MO 63703
Phone (573) 335-2229

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Cape Girardeau County Health Department Organization, Cape Girardeau, MO Medical provider/supplier Other Sep 18, 1986
Gary D Tinsley Individual Other Apr 15, 2025
Nancy K Johnson Individual OtherSecretary/Treasurer Apr 4, 2023
Georganne Syler Individual OtherVice Chairman Apr 1, 2013
John Freeze Individual OtherChairman Jun 1, 2017
Brenda Phillips Individual Operational/Managerial ControlBilling Supervisor Oct 1, 2012
Diane Howard Individual Other Jan 14, 2020
Autumn Grim Individual Corporate DirectorDirector Jul 1, 2023
W-2 Managing EmployeeDirector Jul 1, 2023
Operational/Managerial ControlDirector Jul 1, 2023

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1831174762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1839",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637021839",
            "telephone_number": "573-335-2229",
            "fax_number": "573-339-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 LINDEN ST",
            "address_2": "LOWER LEVEL",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637037708",
            "telephone_number": "573-335-2229",
            "fax_number": "573-339-8768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAPE GIRARDEAU COUNTY HEALTH DEPARTMENT",
        "enumeration_date": "2005-12-14",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "WERNSMAN",
        "authorized_official_first_name": "PEGGY JANE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "573-335-7846",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508534906",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598534907",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CAPE GIRARDEAU COUNTY PUBLIC HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.