NPIMap

Organization Active NPI

Fordland Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fordland, MO
National Provider Identifier
1881607612
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
26-1009 Issued in MO
Legal business name
FORDLAND CLINIC, INC.
Practice address
1059 Barton Dr
Fordland, MO 65652-7350
Phone
(417) 767-2273
Fax
(417) 767-4054
NPI assigned
Aug 14, 2006
Last updated
May 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Authorized official

Name
Teri Simmons
Title
Billing/Credentialing Manager
Phone
(417) 767-2273

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 26-1009 MO Primary

Addresses

Primary practice location

1059 Barton Dr
Fordland, MO 65652-7350

Mailing address

1059 Barton Dr
Fordland, MO 65652-7350
Phone (417) 767-2273

Other identifiers 1

IdentifierTypeStateIssuer
508519105MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050913000367 MO Part B Supplier - Clinic/Group Practice 5597794552 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
Practice locations: Fordland, MO; Kimberling City, MO; Springfield, MO
O20070503000682 MO Part A Provider - Federally Qualified Health Center (FQHC) 5597794552 Practice locations: Fordland, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881607612. Details of each certification follow.

Federally qualified health center certification: CCN 261009

Legal name
FORDLAND CLINIC, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2007
Last certification
Jun 14, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 7, 1997 in MO
Enrollment address
1059 Barton Drive
Fordland, MO 65652-7350

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Paul Farnworth Individual Corporate OfficerVice President May 1, 2013
Corporate Director Nov 1, 2003
Vanessa Owens Individual Corporate Director Jun 27, 2016
William Gdanitz Individual Corporate OfficerPresident Dec 7, 2010
Corporate Director Sep 26, 2006
Kendra Cunningham Individual Corporate Director Aug 2, 2021
Delford E Crewse Individual Corporate Officer Feb 1, 2021
Corporate Director Jul 11, 2011
Valerie Cochara Individual Corporate Director Jul 12, 2021
Pamala S Capps Individual Corporate Director May 3, 2021
Harry Chapin Individual Corporate Director Jul 12, 2021
Joan Twiton Individual W-2 Managing Employee Jul 3, 2017
Michael Dawson Individual Corporate Director Mar 1, 2021
Ray Seiberlich Individual W-2 Managing Employee Jul 3, 2017
Linda Kensinger Individual Corporate OfficerSecretary Jun 5, 2007
Corporate Director Oct 24, 2006

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Fordland Clinic, Inc.Kimberling City, MO, CCN 261102 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2012
Fordland ClinicSpringfield, MO, CCN 261175 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2015

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779753600000",
    "number": "1881607612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 BARTON DR",
            "city": "FORDLAND",
            "state": "MO",
            "postal_code": "656527350",
            "telephone_number": "417-767-2273",
            "fax_number": "417-767-4054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 BARTON DR",
            "city": "FORDLAND",
            "state": "MO",
            "postal_code": "656527350",
            "telephone_number": "417-767-2273",
            "fax_number": "417-767-4054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORDLAND CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "417-767-2273"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MO",
            "license": "26-1009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508519105",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fordland, MO

Sources for this page

Verify at the official NPI Registry.