NPIMap

Organization Active NPI

Community Hospital Association

  • Rural Health Clinic/Center
  • Tarkio, MO
National Provider Identifier
1972507523
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY HOSPITAL ASSOCIATION
Practice address
102 S 6TH St
Tarkio, MO 64491-1513
Phone
(660) 736-4193
Fax
(660) 736-4966
NPI assigned
Jun 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MO
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

102 S 6TH St
Tarkio, MO 64491-1513

Mailing address

102 S 6TH Street
Tarkio, MO 64491-1513
Phone (660) 736-4193

Other identifiers 2

IdentifierTypeStateIssuer
27443017OtherMOBCBS KANSAS CITY MO
505180802MedicaidMO

Other names 2

  • Community Hospital-Fairfax Doing business as
  • Tarkio Family Medicine Doing business as

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
This NPI is an additional NPI on the enrollment
Practice locations: Fairfax, MO; Tarkio, MO; Rock Port, MO; Oregon, MO; Mound City, MO
O20190506000754 MO Part A Provider - Rural Health Clinic 1557316783 Practice locations: Tarkio, MO

Rural health clinic certification: CCN 268771

Legal name
COMMUNITY HOSPITAL ASSOCIATION
Doing business as
TARKIO FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2019
Last certification
Aug 1, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
102 S 6TH St
Tarkio, MO 64491-1513
Related CCNs
261303

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0701055Tarkio Family Medicine102 S 6TH Street, Tarkio, MO 64491Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Community Hospital Association9 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

102 S 6th St
Tarkio, MO 64491
Phone (660) 736-4193

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Dustin Charles Carpenter Individual Corporate DirectorMedical Director Jul 21, 2014
Rebecca Ann Schlueter Individual Corporate OfficerCeo Oct 1, 2025
W-2 Managing EmployeeAd; Oct 1, 2025
Susan Noland Individual Corporate DirectorBoard Member Jul 1, 2018
Community Hospital Association Organization, Fairfax, MO Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2017 100%
Operational/Managerial Control Jul 1, 2017
Corey K. Herron Individual Corporate DirectorBoard Member Feb 25, 2014
Teresa Smith Individual Corporate DirectorBoard Member Jul 1, 2021
Virginia B Low Individual Corporate DirectorVice President Board of Directors Jul 1, 2012
Richard a Burke Individual Corporate DirectorChief of Medical Staff Jul 1, 2007
Christina T a Sticken Individual W-2 Managing EmployeeClinic Billing Coordinator Aug 24, 2015
Operational/Managerial ControlClinic Billing Coordinator Aug 24, 2015
Nebraska Medical Center Organization, Omaha, NE Non-profit Operational/Managerial Control Jul 1, 2017
Timothy L Umbarger Individual Corporate DirectorBoard Member Jul 1, 2018
Tabitha F Wintz Individual Corporate DirectorAssistant Cfo Sep 13, 2014
Rebekah Gebhards Individual Corporate DirectorBoard Member Jul 1, 2018
Garrett Wood Individual Corporate DirectorBoard Member Jul 1, 2018
Jon Phillip Davis Individual Corporate OfficerChief Financial Officer 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 15

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

View all 15

All facility ownership & control disclosures 3

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
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 3

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 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571616000000",
    "number": "1972507523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S 6TH STREET",
            "city": "TARKIO",
            "state": "MO",
            "postal_code": "644911513",
            "telephone_number": "660-736-4193",
            "fax_number": "660-736-4966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S 6TH ST",
            "city": "TARKIO",
            "state": "MO",
            "postal_code": "644911513",
            "telephone_number": "660-736-4193",
            "fax_number": "660-736-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-10",
        "last_updated": "2019-10-21",
        "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": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KANSAS CITY MO",
            "identifier": "27443017",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "505180802",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Hospital-Fairfax",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Hospital-Fairfax",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tarkio Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tarkio, MO

Sources for this page

Verify at the official NPI Registry.