NPIMap

Organization Active NPI

Southeast Missouri Health Network

  • Federally Qualified Health Center (FQHC)
  • Benton, MO
National Provider Identifier
1932108974
Registry record updated Sep 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHEAST MISSOURI HEALTH NETWORK
Practice address
6738 State Highway 77
Benton, MO 63736-8238
Phone
(573) 313-2500
Fax
(573) 313-2505
NPI assigned
Jul 20, 2005
Last updated
Sep 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2026

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

Authorized official

Name
Mallory Matthews, RN
Title
Coo
Phone
(573) 313-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

6738 State Highway 77
Benton, MO 63736-8238

Mailing address

6738 State Highway 77
Benton, MO 63736-8238
Phone (573) 313-2500

Other identifiers 8

IdentifierTypeStateIssuer
400704003MedicaidMO
500704010MedicaidMO
500704028MedicaidMO
500704051MedicaidMO
406126003MedicaidMO
500704036MedicaidMO
406087205MedicaidMO
503973901MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050412000011 MO Part B Supplier - Clinic/Group Practice 6507818044 Receives reassigned benefits from 20 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Caruthersville, MO; Sikeston, MO; New Madrid, MO; Kennett, MO; Bernie, MO; Benton, MO
O20070301000227 MO Part A Provider - Federally Qualified Health Center (FQHC) 6507818044 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kennett, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932108974. Details of each certification follow.

Federally qualified health center certification: CCN 261847

Legal name
SOUTHEAST MISSOURI HEALTH NETWORK
Doing business as
OTTO BEAN MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 21, 1998
Last certification
Sep 21, 1998
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 4, 1994 in MO
Enrollment address
500 Russell St
Kennett, MO 63857-2102

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

Locations

200 Southland Dr
Sikeston, MO 63801
Phone (573) 472-1770

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Lance Crawford Individual Corporate OfficerVice President Sep 1, 2016
Corporate DirectorBoard Member Sep 1, 2016
David Howard Individual Corporate DirectorBoard Member Nov 17, 2014
Scott Lawrence Individual Corporate OfficerCoo Jan 15, 2019
Corporate DirectorBoard Member Jan 15, 2019
Mary Davis Individual Corporate DirectorBoard Member Aug 20, 2007 50%
Christopher Jones Individual Corporate OfficerCeo Dec 10, 2013 16.67%
Don Miller Individual Corporate OfficerPresident Aug 1, 2018
Corporate DirectorBoard Member Aug 1, 2018
Richard Rickman Individual Corporate DirectorBoard Member Dec 1, 2019
Teresa Richey Individual Corporate OfficerDirector of Nursing Jan 25, 2010 16.67%
Mallory Matthews Individual W-2 Managing EmployeeDirector of Clinical Operations Dec 1, 2019
Terunda L Farr Individual W-2 Managing EmployeeBilling Supervisor Dec 5, 2004
Catherine Bockhold Individual Corporate DirectorBoard Member Mar 1, 2011 50%
Cynthia Sharp-Amick Individual Corporate DirectorBoard Member Mar 17, 2014 50%
Sara Deane Individual Corporate OfficerCfo Dec 8, 2014
W-2 Managing EmployeeCfo Dec 8, 2014

Practitioners & affiliated clinicians

Practitioners 4

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": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790208000000",
    "number": "1932108974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A",
        "authorized_official_last_name": "MATTHEWS",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "573-313-2500",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400704003",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500704010",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500704028",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500704051",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406126003",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500704036",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "406087205",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503973901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, MO

Sources for this page

Verify at the official NPI Registry.