NPIMap

Organization Active NPI

Regional Health Care Clinic, Inc.

Doing business as Katy Trail Community Health

  • Federally Qualified Health Center (FQHC)
  • Stover, MO
National Provider Identifier
1942841903
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
41569 Ivy Bend Rd
Stover, MO 65078-2177
Phone
(877) 733-5824
Fax
(888) 979-8868
NPI assigned
Oct 1, 2019
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 NU Primary

Addresses

Primary practice location

41569 Ivy Bend Rd
Stover, MO 65078-2177

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 MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111201000035 MO Part B Supplier - Clinic/Group Practice 8224926092 Receives reassigned benefits from 49 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stover, MO; Versailles, MO
O20200513001649 MO Part A Provider - Federally Qualified Health Center (FQHC) 8224926092 Practice locations: Stover, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942841903. Details of each certification follow.

Federally qualified health center certification: CCN 791003

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
May 14, 2020
Last certification
May 14, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
41569 Ivy Bend Rd
Stover, MO 65078-2177

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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Community Free Clinic I18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Michelle Hendricks Individual Corporate OfficerCeo Jan 1, 2024
Michael Waller Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 7

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": "1569888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1942841903",
    "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": "888-979-8868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41569 IVY BEND RD",
            "city": "STOVER",
            "state": "MO",
            "postal_code": "650782177",
            "telephone_number": "877-733-5824",
            "fax_number": "888-979-8868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGIONAL HEALTH CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-01",
        "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": "NU",
            "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 Stover, MO

Sources for this page

Verify at the official NPI Registry.