NPIMap

Organization Active NPI

Great Mines Health Center

  • Federally Qualified Health Center (FQHC)
  • Farmington, MO
National Provider Identifier
1922446384
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GREAT MINES HEALTH CENTER
Practice address
1401 Maple St
Farmington, MO 63640-8066
Phone
(573) 664-1100
NPI assigned
Jun 7, 2013
Last updated
Aug 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

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

Authorized official

Name
Mr. Gregory Roeback
Title
Ceo
Phone
(573) 438-8380

Specialties & licenses 1

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

Addresses

Primary practice location

1401 Maple St
Farmington, MO 63640-8066

Mailing address

1401 Maple St
Farmington, MO 63640-8066
Phone (573) 664-1100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041004000035 MO Part B Supplier - Clinic/Group Practice 3072598143 Receives reassigned benefits from 34 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cadet, MO; Farmington, MO; Mineral Point, MO; Potosi, MO; Richwoods, MO
O20080130000157 MO Part A Provider - Federally Qualified Health Center (FQHC) 3072598143 1 other NPI on this enrollment
Practice locations: Farmington, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922446384. Details of each certification follow.

Federally qualified health center certification: CCN 261020

Legal name
GREAT MINES HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 3, 2008
Last certification
Mar 3, 2008
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 7, 2002 in MO
Enrollment address
1401 Maple St
Farmington, MO 63640-8066

Other NPIs with the same Medicare PAC ID 4

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
26D2143721Great Mines Health Center of Farmington1401 Maple Street, Farmington, MO 63640Certificate of waiverFeb 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Great Mines Health Center22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

1401 Maple St
Farmington, MO 63640
Phone (573) 664-1100

1 Southtowne Dr
Potosi, MO 63664
Phone (573) 438-8401

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
Melanie Schwalenberg Individual 5% Or Greater Direct Ownership InterestDirector Jul 26, 2021 11.11%
Corporate DirectorDirector Jul 26, 2021 11.11%
Ashleigh Finch Individual 5% Or Greater Direct Ownership InterestBoard Secretary Aug 24, 2020 11.11%
Corporate OfficerBoard Secretary Aug 24, 2020 11.11%
Keri Smith Individual 5% Or Greater Direct Ownership InterestBoard President Aug 27, 2020 11.12%
Corporate OfficerBoard President Aug 27, 2020 11.12%
Mike G Doty Individual 5% Or Greater Direct Ownership InterestDirector Aug 23, 2021 11.11%
Corporate DirectorDirector Aug 23, 2021 11.11%
Gregory a Roeback Individual Corporate OfficerChief Executive Officer Apr 1, 2012 50%
Operational/Managerial ControlChief Executive Officer Apr 1, 2012 50%
Angella King Individual 5% Or Greater Direct Ownership InterestDirector Aug 23, 2021 11.11%
Corporate DirectorDirector Aug 23, 2021 11.11%
Laura Kirkley Individual 5% Or Greater Direct Ownership InterestBoard Treasurer May 24, 2021 11.11%
Corporate OfficerBoard Treasurer May 24, 2021 11.11%
Emily Regenold Individual 5% Or Greater Direct Ownership InterestDirector Sep 21, 2021 11.11%
Corporate DirectorDirector Sep 21, 2021 11.11%
Lee Patterson Individual 5% Or Greater Direct Ownership InterestDirector Sep 21, 2021 11.11%
Corporate DirectorDirector Sep 21, 2021 11.11%
Linda Dickerson Bell Individual 5% Or Greater Direct Ownership InterestBoard Vice President Jan 22, 2020 11.11%
Corporate OfficerBoard Vice President Jan 22, 2020 11.11%

Practitioners & affiliated clinicians

Practitioners 12

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": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755561600000",
    "number": "1922446384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MAPLE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636408066",
            "telephone_number": "573-664-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MAPLE ST",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636408066",
            "telephone_number": "573-664-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT MINES HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-01",
        "status": "A",
        "authorized_official_last_name": "ROEBACK",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-438-8380",
        "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": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.