NPIMap

Organization Active NPI

Cedar County Memorial Hospital

Doing business as CCMH Medical Mall Clinic

  • Clinic/Center
  • El Dorado Springs, MO
National Provider Identifier
1992827273
Registry record updated Apr 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CEDAR COUNTY MEMORIAL HOSPITAL
Doing business as
CCMH Medical Mall Clinic
Practice address
1317 S State Highway 32
El Dorado Springs, MO 64744-2302
Phone
(417) 876-3333
Fax
(417) 876-4509
NPI assigned
Apr 6, 2007
Last updated
Apr 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CEDAR COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2026

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

Authorized official

Name
Donald L Carpenter
Title
Ceo
Phone
(417) 876-2511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1317 S State Highway 32
El Dorado Springs, MO 64744-2302

Mailing address

1401 S Park St
El Dorado Springs, MO 64744-2037
Phone (417) 876-2511

Other names 2

  • CCMH Medical Mall Clinic Doing business as
  • Professional Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041027000976 MO Part B Supplier - Clinic/Group Practice 7315841129 Receives reassigned benefits from 11 practitioners
Practice locations: El Dorado Springs, MO

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Cedar County Memorial Hospital

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Cedar County Memorial HospitalEl Dorado Springs, MO, CCN 261323 Hospital Operational/Managerial Control (100%) Dec 31, 1991
Cedar County Memorial HospitalEl Dorado Springs, MO, CCN 26Z323 Hospital Operational/Managerial Control (100%) Dec 31, 1991
CCMH Medical Mall ClinicEl Dorado Springs, MO, CCN 263474 Rural health clinic Operational/Managerial Control (100%) Oct 30, 1995

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 11

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": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775001600000",
    "number": "1992827273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S PARK ST",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442037",
            "telephone_number": "417-876-2511",
            "fax_number": "417-876-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S STATE HIGHWAY 32",
            "city": "EL DORADO SPRINGS",
            "state": "MO",
            "postal_code": "647442302",
            "telephone_number": "417-876-3333",
            "fax_number": "417-876-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CEDAR COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2007-04-06",
        "last_updated": "2026-04-01",
        "certification_date": "2026-04-01",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "417-876-2511"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCMH Medical Mall Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCMH Medical Mall Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Professional Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in El Dorado Springs, MO

Sources for this page

Verify at the official NPI Registry.