NPIMap

Organization Active NPI

Community Hospital Association

  • Critical Access Hospital
  • Fairfax, MO
National Provider Identifier
1942279500
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
102-48 Issued in MO
Legal business name
COMMUNITY HOSPITAL ASSOCIATION
Practice address
26136 US Highway 59
Fairfax, MO 64446-8155
Phone
(660) 686-2211
Fax
(660) 686-2618
NPI assigned
Mar 16, 2006
Last updated
Mar 30, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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

Authorized official

Name
Jon P Davis
Title
Cfo
Phone
(660) 686-2320

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 102-48 MO Primary

Addresses

Primary practice location

26136 US Highway 59
Fairfax, MO 64446-8155

Mailing address

26136 US Hwy 59
Fairfax, MO 64446-9105
Phone (660) 686-2211

Other identifiers 3

IdentifierTypeStateIssuer
010492502MedicaidMO
90060015OtherMOBCBS OF KANSAS CITY
540492501MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050321000427 MO Part B Supplier - Clinic/Group Practice 1557316783 Receives reassigned benefits from 8 practitioners
6 other NPIs on this enrollment
Practice locations: Fairfax, MO; Tarkio, MO; Rock Port, MO; Oregon, MO; Mound City, MO
O20081126000543 MO Part A Provider - Critical Access Hospital 1557316783 Receives reassigned benefits from 18 practitioners
Practice locations: Fairfax, MO; Mound City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942279500. Details of each certification follow.

Hospital certification: CCN 261303

Legal name
COMMUNITY HOSPITAL ASSOCIATION
Doing business as
COMMUNITY HOSPITAL ASSOCIATION
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2000
Last certification
Feb 8, 2018
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
26136 US Highway 59
Box 107
Fairfax, MO 64446-9105
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

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 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Hospital AssociationCCN 261303 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Community Hospital Assoc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

26136 US Highway 59
#107
Fairfax, MO 64446
Phone (660) 686-2211

514 State St
Mound City, MO 64470
Phone (660) 442-3181

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rebecca Ann Schlueter Individual Corporate OfficerCeo Oct 1, 2025
W-2 Managing EmployeeAd; Oct 1, 2025
Corey K. Herron Individual Corporate DirectorBoard Member Feb 25, 2014
Virginia B Low Individual Corporate DirectorChairman of the Board Jul 1, 2012
Richard a Burke Individual Corporate DirectorChief of Medical Staff Jul 1, 2007
Nebraska Medical Center Organization, Omaha, NE Operational/Managerial Control Oct 13, 2008
Timothy L Umbarger Individual Corporate DirectorBoard Member Jul 1, 2018
Tabitha F Wintz Individual Operational/Managerial ControlRevenue Cycle Manager Sep 1, 2014
Rebekah Gebhards Individual Corporate DirectorSecretary/Treasure of the Board Jul 1, 2018
Garrett Wood Individual Corporate DirectorBoard Member Jul 1, 2018
Jon Phillip Davis Individual Corporate OfficerCfo Apr 1, 2015
Thomas Bullock Individual Corporate DirectorBoard Member Jul 1, 2021
Glenn R. Scott Individual Corporate DirectorBoard Member Jul 1, 2014

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
South Holt Family MedicineOregon, MO, CCN 268753 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 5, 2016
Jan 5, 2016
Mound City Family MedicineMound City, MO, CCN 268755 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 5, 2016
Jan 5, 2016
Tarkio Family MedicineTarkio, MO, CCN 268771 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jul 1, 2017
Jul 1, 2017
Fairfax Family MedicineFairfax, MO, CCN 268770 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 3, 2018
Oct 3, 2018

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 24

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 24

Affiliated clinicians 39

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490832000000",
    "number": "1942279500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26136 US HWY 59",
            "city": "FAIRFAX",
            "state": "MO",
            "postal_code": "644469105",
            "telephone_number": "660-686-2211",
            "fax_number": "660-686-2618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26136 US HIGHWAY 59",
            "city": "FAIRFAX",
            "state": "MO",
            "postal_code": "644468155",
            "telephone_number": "660-686-2211",
            "fax_number": "660-686-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-16",
        "last_updated": "2017-03-30",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "660-686-2320"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MO",
            "license": "102-48",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010492502",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KANSAS CITY",
            "identifier": "90060015",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540492501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, MO

Sources for this page

Verify at the official NPI Registry.