NPIMap

Organization Active NPI

Advocates for a Healthy Community, Inc.

Doing business as Jordan Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Springfield, MO
National Provider Identifier
1861590861
Registry record updated Dec 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ADVOCATES FOR A HEALTHY COMMUNITY, INC.
Doing business as
Jordan Valley Community Health Center
Practice address
618 N Benton Ave
Springfield, MO 65806-1102
Phone
(417) 831-0150
Fax
(417) 831-0155
NPI assigned
Sep 21, 2006
Last updated
Dec 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2021

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

Authorized official

Name
Mr. Kenneth B Miller Jr., CEO
Title
Ceo
Phone
(417) 831-0150

Specialties & licenses 1

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

Addresses

Primary practice location

618 N Benton Ave
Springfield, MO 65806-1102

Mailing address

440 E Tampa St
Springfield, MO 65806-1131
Phone (417) 851-1551

Other identifiers 2

IdentifierTypeStateIssuer
506226703MedicaidMO
26D1013631OtherMOCLIA

Other names 1

  • Jordan Valley Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170731000026 MO Part A Provider - Federally Qualified Health Center (FQHC) 5395653562 Practice locations: Springfield, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861590861. Details of each certification follow.

Federally qualified health center certification: CCN 261138

Legal name
ADVOCATES FOR A HEALTHY COMMUNITY INC
Doing business as
JORDAN VALLEY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 27, 2017
Last certification
Jul 27, 2017
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Feb 21, 1992 in MO
Enrollment address
618 N Benton Ave
Springfield, MO 65806-1102

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Amy Poe Individual Corporate DirectorBoard Member Jan 1, 2022
Jeff Davis Individual Corporate DirectorBoard Member Jan 1, 2022
Yadira Howe Individual W-2 Managing EmployeeExecutive Vice President, Adm Mar 20, 2024
Kenneth B Miller Individual Corporate OfficerCeo Aug 12, 2002
Christy Wilson Individual W-2 Managing EmployeeDirector, Revenue Cycle Mar 20, 2024
Mendie Schoeller Individual Corporate DirectorBoard Member Jan 1, 2022
Matthew Stinson Individual Corporate OfficerCeo Jun 1, 2024
Trey Peck Individual Corporate DirectorBoard Member Jan 1, 2022
Kevin Gipson Individual Corporate DirectorBoard Member Jan 1, 2022
John Twitty Individual Corporate OfficerChair Jun 1, 2016
Corporate DirectorBoard Member Jun 1, 2011
Phil Brown Individual Corporate OfficerBoard Member Jun 1, 2022
Richard Hardy Individual Corporate DirectorBoard Member Jan 1, 2022
Carol Dehaven Janick Individual Corporate OfficerSecretary/Treasurer Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
Mike Schnake Individual Corporate OfficerVice Chair Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2022
Rita Gurian Individual Corporate OfficerBoard Member Jun 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 59

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 59

NPI Registry JSON

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638403200000",
    "number": "1861590861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 E TAMPA ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658061131",
            "telephone_number": "417-851-1551",
            "fax_number": "417-831-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 N BENTON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658061102",
            "telephone_number": "417-831-0150",
            "fax_number": "417-831-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATES FOR A HEALTHY COMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-831-0150",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506226703",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D1013631",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jordan Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.