NPIMap

Organization Active NPI

Douglas County Public Health Services Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Mansfield, MO
National Provider Identifier
1912904004
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Practice address
804 N Highway 5
Mansfield, MO 65704-7301
Phone
(417) 924-8809
Fax
(417) 924-8870
NPI assigned
Jul 5, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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

Authorized official

Name
Mr. Richard R Sims
Title
Ceo
Phone
(417) 683-4831

Specialties & licenses 1

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

Addresses

Primary practice location

804 N Highway 5
Mansfield, MO 65704-7301

Mailing address

PO Box 257
Mansfield, MO 65704-0257
Phone (417) 924-8809

Other names 1

  • Missouri Ozarks Community Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050301000128 MO Part B Supplier - Clinic/Group Practice 3072423052 Receives reassigned benefits from 33 practitioners
9 other NPIs on this enrollment
Practice locations: Ava, MO; Theodosia, MO; Mountain Grove, MO; Mansfield, MO; Licking, MO; Houston, MO; Gainesville, MO; Cabool, MO
O20100920000560 MO Part A Provider - Federally Qualified Health Center (FQHC) 3072423052 Practice locations: Mansfield, MO

Federally qualified health center certification: CCN 261881

Legal name
DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.
Doing business as
MISSOURI OZARKS COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 27, 2005
Last certification
Jan 27, 2005
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 9, 1996 in MO
Enrollment address
804N Highway 5
Mansfield, MO 65704-7301

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 9

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

National Provider Directory

National Provider Directory
Tax ID family
Douglas County Public Health Services Group Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

603 W Broadway Ave
Ava, MO 65608

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Bart Ellison Individual Corporate Director Sep 17, 2014
Aaron Dalton Individual Corporate Director Apr 21, 2021
Ronald Scheets Individual Corporate Director Jun 12, 2013
Rhonda Suter Individual Corporate Director Apr 9, 2001
Carol Cunningham Individual Corporate Director Feb 19, 1998
Tim Shryack Individual Corporate OfficerCeo Jun 17, 2013 100%
Donald Pinckney Individual Corporate Director Jan 30, 1997
Ann Leonard Individual Corporate Director Jul 15, 2020
Jennifer D Heinlein Individual W-2 Managing EmployeeExec Assistant/Hro Jan 1, 2014 25%
Operational/Managerial ControlHro Jan 1, 2014 50%
Valerie Reece Individual Corporate Director Aug 8, 2012

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1912904004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 257",
            "city": "MANSFIELD",
            "state": "MO",
            "postal_code": "657040257",
            "telephone_number": "417-924-8809",
            "fax_number": "417-924-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 N HIGHWAY 5",
            "city": "MANSFIELD",
            "state": "MO",
            "postal_code": "657047301",
            "telephone_number": "417-924-8809",
            "fax_number": "417-924-8870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY PUBLIC HEALTH SERVICES GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "SIMS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-683-4831",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Missouri Ozarks Community Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, MO

Sources for this page

Verify at the official NPI Registry.