NPIMap

Organization Active NPI

Cedar County Memorial Hospital

Doing business as CCMH Medical Mall Clinic

  • Rural Health Clinic/Center
  • El Dorado Springs, MO
National Provider Identifier
1881608685
Registry record updated Apr 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CEDAR COUNTY MEMORIAL HOSPITAL
Doing business as
CCMH Medical Mall Clinic
Practice address
1317 S State Highway 32
El Dorado Springs, MO 64744-2302
Phone
(417) 876-3333
Fax
(417) 876-4509
NPI assigned
Jul 28, 2006
Last updated
Apr 2, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CEDAR COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2026

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

Authorized official

Name
Donald L Carpenter
Title
Ceo
Phone
(417) 876-2511

Specialties & licenses 1

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

Addresses

Primary practice location

1317 S State Highway 32
El Dorado Springs, MO 64744-2302

Mailing address

1401 S Park St
El Dorado Springs, MO 64744-2037
Phone (417) 876-2511

Other identifiers 1

IdentifierTypeStateIssuer
598157600MedicaidMO

Other names 1

  • CCMH Medical Mall Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100615000060 MO Part A Provider - Rural Health Clinic 7315841129 Practice locations: El Dorado Springs, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881608685. Details of each certification follow.

Rural health clinic certification: CCN 263474

Legal name
CEDAR COUNTY MEMORIAL HOSPITAL
Doing business as
CCMH MEDICAL MALL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 1995
Last certification
Nov 2, 2022
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1317 S State Highway 32
El Dorado Springs, MO 64744-2302
Related CCNs
261323

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Cedar County Memorial Hospital4 organizations share this tax ID, including this one
Part of
Cedar County Memorial Hospital

Other organizations with this tax ID 3

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

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
Donald Lee Carpenter Individual Corporate OfficerCeo Mar 2, 2026
Corporate DirectorCeo Mar 2, 2026
W-2 Managing EmployeeCeo Mar 2, 2026
Carla Gilbert Individual Corporate OfficerCfo Feb 1, 2022
Corporate DirectorCfo Feb 1, 2022
W-2 Managing EmployeeCfo Feb 1, 2022
Gregory Scott Castor Individual Corporate OfficerBoard Member Nov 13, 2025
Peggy Kenney Individual Corporate OfficerBoard Member Apr 15, 2025
Cedar County Memorial Hospital Organization, El Dorado Springs, MO Non-profit Operational/Managerial Control Oct 30, 1995 100%
Katie McGee Individual Corporate OfficerBoard Member Apr 11, 2022
Melissa Ann Gallette Individual Corporate OfficerBoard Member Apr 16, 2024
Marvin Manring Individual Corporate OfficerBoard Member Apr 16, 2018

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cedar County Memorial HospitalEl Dorado Springs, MO, CCN 261323 Hospital Operational/Managerial Control (100%) Dec 31, 1991
Cedar County Memorial HospitalEl Dorado Springs, MO, CCN 26Z323 Hospital Operational/Managerial Control (100%) Dec 31, 1991

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775088000000",
    "number": "1881608685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S PARK ST",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442037",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S STATE HIGHWAY 32",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442302",
            "telephone_number": "417-876-3333",
            "fax_number": "417-876-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CEDAR COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-28",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-876-2511"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "598157600",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Medical Mall Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCMH Medical Mall Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado Springs, MO

Sources for this page

Verify at the official NPI Registry.