NPIMap

Organization Active NPI

Cross Trails Medical Center

  • Federally Qualified Health Center (FQHC)
  • Marble Hill, MO
National Provider Identifier
1962565499
Registry record updated Mar 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CROSS TRAILS MEDICAL CENTER
Practice address
109 Hwy 51 North
Marble Hill, MO 63764
Phone
(573) 238-2725
Fax
(573) 238-3795
NPI assigned
Dec 18, 2006
Last updated
Mar 18, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
CROSS TRAILS MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2014

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

Authorized official

Name
Mona Wells
Title
Cfo
Phone
(573) 339-1196

Specialties & licenses 1

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

Addresses

Primary practice location

109 Hwy 51 North
Marble Hill, MO 63764

Mailing address

PO Box 349
Marble Hill, MO 63764-0349
Phone (573) 238-2725

Other identifiers 2

IdentifierTypeStateIssuer
CD9626OtherMORAILROAD MEDICARE
508082815MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031114000205 MO Part B Supplier - Clinic/Group Practice 8820902851 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Perryville, MO; Marble Hill, MO; Cape Girardeau, MO; Advance, MO
O20070209000600 MO Part A Provider - Federally Qualified Health Center (FQHC) 8820902851 Practice locations: Marble Hill, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962565499. Details of each certification follow.

Federally qualified health center certification: CCN 261837

Legal name
CROSS TRAILS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 1995
Last certification
Oct 2, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 1, 1994 in MO
Enrollment address
109 Hwy 51 N
Marble Hill, MO 63764

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 4

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

National Provider Directory

National Provider Directory
Tax ID family
Cross Trails Medical Ce9 organizations share this tax ID, including this one
Part of
Cross Trails Medical Ce

Other organizations with this tax ID 8

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

Locations

408 S Broadview St
Cpe Girardeau, MO 63703
Phone (573) 332-0808

109 State Highway 51 N
Marble Hill, MO 63764
Phone (573) 238-1110

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
Rebecca Garris Individual Corporate DirectorBoard Member Mar 1, 2024
Chrissy Warren Individual Corporate OfficerCoo Jul 28, 2010
Fran Seabaugh Individual Corporate DirectorBoard Member Jan 1, 1995
Amy Lanzotti Individual Corporate OfficerCfo Jul 1, 2024
Kathy Hotop-Raines Individual Corporate Director Aug 27, 2010
Greg Nenninger Individual Corporate DirectorBoard Member Nov 1, 2004
Cathi Greer Individual Corporate DirectorBoard Member Dec 1, 2006
Laura Griffin Individual Corporate DirectorBoard Member Jul 1, 2016
Cindy Beussink Individual Corporate DirectorBoard Member Nov 8, 2008
Val Crader Individual Corporate DirectorBoard Member Aug 1, 2011
Rick Francis Individual Corporate OfficerCeo Apr 1, 2024
Glynda J Burford Individual Corporate DirectorBoard Member Aug 1, 2015
Sheila Pruitt Individual W-2 Managing EmployeeBilling Coordinator May 26, 2010

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Cross Trails Medical CenterPerryville, MO, CCN 261068 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2014
Cross Trails Medical CenterCape Girardeau, MO, CCN 261936 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 19, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1962565499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 349",
            "city": "MARBLE HILL",
            "state": "MO",
            "postal_code": "637640349",
            "telephone_number": "573-238-2725",
            "fax_number": "573-238-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 HWY 51 NORTH",
            "city": "MARBLE HILL",
            "state": "MO",
            "postal_code": "63764",
            "telephone_number": "573-238-2725",
            "fax_number": "573-238-3795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSS TRAILS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CROSS TRAILS MEDICAL CENTER",
        "enumeration_date": "2006-12-18",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "MONA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-339-1196"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD9626",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508082815",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marble Hill, MO

Sources for this page

Verify at the official NPI Registry.