NPIMap

Organization Active NPI

Regional Health Care Clinic Inc

Doing business as Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Sedalia, MO
National Provider Identifier
1922057504
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
Katy Trail Community Health
Practice address
821 Westwood Dr
Sedalia, MO 65301-2102
Phone
(660) 826-4774
Fax
(660) 826-1300
NPI assigned
May 9, 2006
Last updated
Feb 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Authorized official

Name
Michael Waller
Title
Ceo
Phone
(660) 826-4774

Specialties & licenses 1

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

Addresses

Primary practice location

821 Westwood Dr
Sedalia, MO 65301-2102

Mailing address

821 Westwood Dr
Sedalia, MO 65301-2102
Phone (660) 826-4774

Other names 1

  • Katy Trail Community Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040304001212 MO Part B Supplier - Clinic/Group Practice 8224926092 Receives reassigned benefits from 57 practitioners
5 other NPIs on this enrollment
Practice locations: Cole Camp, MO; Green Ridge, MO; Marshall, MO; Sedalia, MO; Warsaw, MO
O20041102000858 MO Part A Provider - Federally Qualified Health Center (FQHC) 8224926092 Practice locations: Sedalia, MO
O20060907000591 MO Part A Provider - Federally Qualified Health Center (FQHC) 8224926092 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1922057504. Details of each certification follow.

Federally qualified health center certification: CCN 261879

Legal name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
KATY TRAIL COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2004
Last certification
Dec 8, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
821 Westwood Dr
Sedalia, MO 65301-2102

Federally qualified health center certification: CCN 261005

Legal name
REGIONAL HEALTH CARE CLINIC INC
Doing business as
KATY TRAIL COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2006
Last certification
Oct 17, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 3, 1999 in MO
Enrollment address
17571 N Dam Access Rd
Warsaw, MO 65355-6396

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 5

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
26D1014838Katy Trail Community Health821 Westwood Drive, Sedalia, MO 65301Certificate of waiverDec 25, 2026

National Provider Directory

National Provider Directory

Locations

1825 Atchison Ave
Marshall, MO 65340
Phone (660) 886-3434

565 S Odell Ave
Marshall, MO 65340

600 S Warren Ave
Sedalia, MO 65301

701 N Oak St
Stover, MO 65078
Phone (573) 377-2217

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Angela Saran Individual Corporate Director Jan 1, 2010
Linda Messenger Individual Corporate Director Nov 11, 2004
Michelle Hendricks Individual Corporate OfficerCfo Jan 1, 2024
Michael Waller Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
Rhonda Breitenbecher Individual Corporate Director Jan 1, 2010
Darren Grove Individual Corporate OfficerBoard President Sep 25, 2025 100%
Marie Payne-Bowman Individual Corporate Director Jan 1, 2010

Practitioners & affiliated clinicians

Practitioners 58

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 58

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1922057504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 WESTWOOD DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012102",
            "telephone_number": "660-826-4774",
            "fax_number": "660-826-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 WESTWOOD DR",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653012102",
            "telephone_number": "660-826-4774",
            "fax_number": "660-826-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "660-826-4774"
    },
    "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": "Katy Trail Community Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Katy Trail Community Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sedalia, MO

Sources for this page

Verify at the official NPI Registry.