Regional Health Care Clinic Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Sedalia, MO
NPI 1922057504 · NPPES record last updated Feb 21, 2024
Key facts
- NPI
- 1922057504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- REGIONAL HEALTH CARE CLINIC INC
- Practice address
- 821 Westwood Dr
Sedalia, MO 65301-2102 - Phone
- (660) 826-4774
- Fax
- (660) 826-1300
- NPI assigned
- May 9, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Waller
- Title
- Ceo
- Phone
- (660) 826-4774
Other NPIs on the same Medicare enrollment 5
Other NPIs with the same Medicare PAC ID 6
Practitioners 59
-
Molly Boston, LCSW
-
Cori Lynne Bradshaw, APRN
-
Jenie Bruce, NP
-
Lynda G Carlyle, FNP
-
Jeffrey S Carver, FNP
-
Brianna Cordova, LCSW
-
Justin Robert Cramer, M.D.
-
Mary J Drenon, FNP
-
Kayla Jean Evans, FNP
-
Bhavini Gopaldas, PA
-
Chauncey B Haley, O.D.
-
Madison Hohne, FNP
-
Yasmin Dara Jilla, M.D.
-
Teri C Lada, LPC
-
Sylvia Lawson-Cook, LCSW
-
Alecia Kimberly Liburd, PMHNP
-
Stephanie R Nicholson, FNP-C
-
Angela Dawn Pike, DNP, FNP-C, PMHNP-BC
-
Megan Rowland, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D1014838 | Katy Trail Community Health | Certificate of waiver | Dec 25, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO
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
- Corporation · Non-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
- Corporation · Non-profit
- Incorporated
- Nov 3, 1999 in MO
- Enrollment address
- 17571 N Dam Access Rd
Warsaw, MO 65355-6396
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Angela Saran |
Corporate Director | Jan 1, 2010 | |
| Linda Messenger |
Corporate Director | Nov 11, 2004 | |
| Michelle Hendricks |
Corporate Officer |
Jan 1, 2024 | |
| Michael Waller |
Corporate Officer |
Jan 1, 2024 | |
| W-2 Managing Employee | Jan 1, 2024 | ||
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Rhonda Breitenbecher |
Corporate Director | Jan 1, 2010 | |
| Darren Grove |
Corporate Officer |
Sep 25, 2025 | 100% |
| Marie Payne-Bowman |
Corporate Director | Jan 1, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
805 S Miami Ave
Marshall, MO 65340
305 W Main St
Sedalia, MO 65301
Phone (660) 310-0909
1100 W 16th St
Sedalia, MO 65301
Phone (660) 826-6441
600 S Warren Ave
Sedalia, MO 65301
701 N Oak St
Stover, MO 65078
Phone (573) 377-2217
134 W Kosciusko St
Warsaw, MO 65355
Phone (604) 386-2606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Katy Trail Community Health
Other providers in Sedalia, MO
- Kevin Michael Ree
- Keeper Elsie Eugenia Reece
- Regional Health Care Clinic Inc
- Regional Health Care Clinic Inc
- Regional Health Care Clinic Inc
- Regional Health Care Clinic, Inc
- Regional Health Care Clinic, Inc.
- Regional Health Care Clinic, Inc.
- Roger Allen Reid
- Rest Haven Health Care Center, L.L.C.
All providers in Sedalia, MO · Federally Qualified Health Center (FQHC) in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.