NPIMap

Organization Active NPI

Community Health Ctr of Central Missouri

Doing business as Community Health Center of Central Missouri-Christy Drive

  • Federally Qualified Health Center (FQHC)
  • Jefferson City, MO
National Provider Identifier
1972001386
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Doing business as
Community Health Center of Central Missouri-Christy Drive
Practice address
1511 Christy Dr
Jefferson City, MO 65101-2854
Phone
(573) 632-2777
Fax
(573) 632-2769
NPI assigned
Jan 31, 2018
Last updated
Oct 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

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

Authorized official

Name
Mr. Toby Barnett
Title
Cfo
Phone
(573) 632-2777

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Clinical Social Worker 1041C0700X NU
Dentist 122300000X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1511 Christy Dr
Jefferson City, MO 65101-2854

Mailing address

PO Box 104780
Jefferson City, MO 65110-4780
Phone (573) 632-2777

Other names 1

  • Community Health Center of Central Missouri-Christy Drive Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050610000717 MO Part B Supplier - Clinic/Group Practice 2062456015 Receives reassigned benefits from 31 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: California, MO; Fulton, MO; Jefferson City, MO; Linn, MO
O20180402000068 MO Part A Provider - Federally Qualified Health Center (FQHC) 2062456015 Practice locations: Jefferson City, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972001386. Details of each certification follow.

Federally qualified health center certification: CCN 261155

Legal name
COMMUNITY HEALTH CTR OF CENTRAL MISSOURI
Doing business as
COMMUNITY HEALTH CTR OF CENTRAL MISSOURI-CHRISTY DRIVE
Organization structure
OtherNon-profit
Incorporated
Mar 17, 2003 in MO
Enrollment address
1511 Christy Dr
Jefferson City, MO 65101-2854

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center of Central Missouri5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

606 E Buchanan St
California, MO 65018
Phone (573) 796-3600

408 Dix Rd
Jefferson City, MO 65109
Phone (573) 638-3897

1811 Highway 50 E
Linn, MO 65051
Phone (573) 897-4946

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jackie Coleman Individual Corporate OfficerBoard Member Oct 17, 2018
Kristi Campbell Individual Corporate OfficerBoard Member Jan 29, 2014
Thomas a Luebbering Individual Corporate OfficerBoard Member Oct 1, 2019
Linda Bickel Individual Corporate OfficerBoard Member Jan 29, 2014
Amanda Grellner Individual Corporate OfficerBoard Member Jan 29, 2014
Darrel King Individual Corporate OfficerBoard Member Jan 29, 2014
Beverly Stafford Individual Corporate OfficerBoard Member Jan 29, 2014
Linda McAnany Individual Corporate OfficerBoard Member Jan 29, 2014
Debbie Hamler Individual Corporate OfficerBoard Member Jan 29, 2014
Kathy Dothage Individual Corporate OfficerBoard Member Jan 29, 2014
Thomas a Niekamp Individual Corporate OfficerBoard Member Jan 29, 2014
Crystal L Sullivan Individual Corporate OfficerCeo Jan 29, 2014
Christine Ellinger Individual Corporate OfficerBoard Member Jan 29, 2014
Toby L Barnett Individual Corporate OfficerCfo Jan 29, 2014
W-2 Managing EmployeeCfo Jan 29, 2014

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1517356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1972001386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 104780",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651104780",
            "telephone_number": "573-632-2777",
            "fax_number": "573-632-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 CHRISTY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012854",
            "telephone_number": "573-632-2777",
            "fax_number": "573-632-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CTR OF CENTRAL MISSOURI",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-31",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "BARNETT",
        "authorized_official_first_name": "TOBY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "573-632-2777",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Center of Central Missouri-Christy Drive",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.