Great Mines Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

GREAT MINES HEALTH CENTER

Practice address

512 State St RM 101
Mineral Point, MO 63660-8208

Phone

(573) 438-9355

Fax

(573) 438-7892

NPI assigned

Aug 16, 2019

Last updated

Aug 16, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gregory Roeback, MA,NCC,LPC,PHR,SHRMCNPI 1033683354

Title

Ceo

Phone

(573) 438-9355

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Potosi, MO
  • NPI 1376536953

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Cadet, MO
  • NPI 1548750847

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Family Medicine Physician
  • De Soto, MO
  • NPI 1669654638

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Farmington, MO
  • NPI 1750563722

  O20041004000035

  Same enrollment
• Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Farmington, MO
  • NPI 1922446384

  O20041004000035

  Same enrollment

Practitioners 1

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.

• Gregory A Roeback, LPC

  • Professional Counselor
  • Potosi, MO
  • NPI 1033683354
  Authorized official Same address or phone

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

{
    "created_epoch": "1565913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565913600000",
    "number": "1891341665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 761",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636640761",
            "telephone_number": "573-438-9355",
            "fax_number": "573-438-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 STATE ST RM 101",
            "city": "MINERAL POINT",
            "state": "MO",
            "postal_code": "636608208",
            "telephone_number": "573-438-9355",
            "fax_number": "573-438-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT MINES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-16",
        "last_updated": "2019-08-16",
        "status": "A",
        "authorized_official_last_name": "ROEBACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-438-9355",
        "authorized_official_credential": "MA,NCC,LPC,PHR,SHRMC"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HRSA",
            "identifier": "H80CS06870-13-02",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in Mineral Point, MO
• Providers in Mineral Point, MO by specialty
• Federally Qualified Health Center (FQHC) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.