NPIMap

Organization Active NPI

Bates County Memorial Hospital

Doing business as Family Care Clinic High

  • Rural Health Clinic/Center
  • Butler, MO
National Provider Identifier
1902851843
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
205 49 Issued in MO
Legal business name
BATES COUNTY MEMORIAL HOSPITAL
Doing business as
Family Care Clinic High
Practice address
706 S High St
Butler, MO 64730-1833
Phone
(660) 200-7135
Fax
(660) 200-7015
NPI assigned
May 22, 2006
Last updated
Aug 15, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BATES COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Gregory Weaver
Title
Ceo
Phone
(660) 200-7000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 205 49 MO Primary
Family Medicine Physician 207Q00000X 205 45 MO

Addresses

Primary practice location

706 S High St
Butler, MO 64730-1833

Mailing address

706 S High St
Butler, MO 64730-1833
Phone (660) 200-7135

Other identifiers 2

IdentifierTypeStateIssuer
590472908MedicaidMO
24435010OtherMOBLUE CROSS

Other names 1

  • Family Care Clinic High Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040121000624 MO Part B Supplier - Clinic/Group Practice 8123937356 Receives reassigned benefits from 90 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adrian, MO; Butler, MO; Rich Hill, MO
O20100422000371 MO Part A Provider - Rural Health Clinic 8123937356 Practice locations: Butler, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902851843. Details of each certification follow.

Rural health clinic certification: CCN 268646

Legal name
BATES COUNTY MEMORIAL HOSPITAL
Doing business as
FAMILY CARE CLINIC HIGH
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 15, 2009
Last certification
Mar 2, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
706 S High St
Butler, MO 64730-1833
Related CCNs
260034

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0445329Family Care Clinic High St706 S High St, Butler, MO 64730Certificate of waiverFeb 29, 2028

National Provider Directory

National Provider Directory
Part of
Primary Care Specialist

Locations

706 S High St
Butler, MO 64730
Phone (660) 200-7135

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Gregory a Weaver Individual Corporate Director Sep 1, 2020
Operational/Managerial Control Sep 1, 2020
Linda Jennings Individual Corporate OfficerVice Chairman Apr 1, 2020
Jerry Jones Individual Corporate OfficerMember Apr 1, 2020
James Shade Individual Corporate OfficerChairman Apr 1, 2020
Bates County Memorial Hospital Organization, Butler, MO Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1990 100%
Richard R King Individual Corporate OfficerTreasurer Apr 1, 2020

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Bates County Memorial HospitalButler, MO, CCN 260034 Hospital Operational/Managerial Control Mar 3, 2003
Bates County Memorial HospitalButler, MO, CCN 26U034 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2008
Family Care Clinic AdrianAdrian, MO, CCN 268667 Rural health clinic 5% Or Greater Direct Ownership Interest May 14, 1991
Family Care Clinic Rich HillRich Hill, MO, CCN 268749 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2016

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1902851843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 S HIGH ST",
            "city": "BUTLER",
            "state": "MO",
            "postal_code": "647301833",
            "telephone_number": "660-200-7135",
            "fax_number": "660-200-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 S HIGH ST",
            "city": "BUTLER",
            "state": "MO",
            "postal_code": "647301833",
            "telephone_number": "660-200-7135",
            "fax_number": "660-200-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATES COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BATES COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2006-05-22",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-200-7000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": "205 49",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "205 45",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590472908",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "24435010",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Care Clinic High",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Care Clinic High",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Butler, MO

Sources for this page

Verify at the official NPI Registry.