OTTO BEAN MEDICAL CENTER
NPI 1710108766
Clinic/Center - Federally Qualified Health Center (FQHC) in Kennett, MO

NPI Status: Active since May 01, 2007

Contact Information

500 RUSSELL ST
KENNETT, MO
ZIP 63857
Phone: (573) 717-1332
Fax: (573) 717-1335

NPI Profile Information
Primary Taxonomy
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Federally Qualified Health Center (FQHC)
Accepts Insurance
CLIA Number: 26D0924445
CLIA Cert. Type: Physician Office
CLIA Exp. Date: 09-25-2025

About OTTO BEAN MEDICAL CENTER

This page provides the complete NPI Profile along with additional information for Otto Bean Medical Center, a primary care provider established in Kennett, Missouri operating as a Clinic/center, focusing in federally qualified health center (fqhc) . The healthcare provider is registered in the NPI registry with number 1710108766 assigned on May 2007. The practitioner's primary taxonomy code is 261QF0400X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Otto Bean Medical Center. The authorized official of this NPI record is Sara Deane (Chief Financial Officer)

NPI: 1710108766
Provider Legal Name: SOUTHEAST MISSOURI HEALTH NETWORK
Other Organization Name: OTTO BEAN MEDICAL CENTER
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 500 RUSSELL ST KENNETT, MO 63857
Location Phone: (573) 717-1332
Location Fax: (573) 717-1335
Mailing Address: 6738 STATE HIGHWAY 77 BENTON, MO 63736
Mailing Phone: (573) 313-2500
Mailing Fax: (573) 717-1335
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 05-01-2007
Last Update Date: 04-14-2020
Code Navigator

A primary care provider (PCP) like Otto Bean Medical Center sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Federally Qualified Health Center (FQHC)
Taxonomy Code: 261QF0400X
Type: Ambulatory Health Care Facilities

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Ambetter from Arkansas Health & Wellness

Choice Bronze HSA (QualChoice) - POS
Complete Gold - PPO
Complete Gold + Vision + Adult Dental - PPO
Complete Silver (QualChoice) - POS
Connected Silver - PPO
Connected Silver (QualChoice) - POS
Connected Silver (QualChoiceLife) - PPO
Connected Silver + Vision + Adult Dental - PPO
Elite Bronze - PPO
Elite Bronze + Vision + Adult Dental - PPO
Elite Gold (QualChoice) - POS
Elite Gold (QualChoiceLife) - PPO
Everyday Bronze - PPO
Everyday Bronze + Vision + Adult Dental - PPO
Everyday Gold - PPO
Everyday Gold + Vision + Adult Dental - PPO
Everyday Silver (QualChoiceLife) - PPO
Focused Silver - PPO
Focused Silver + Vision + Adult Dental - PPO
Standard Expanded Bronze - PPO

Ambetter from Home State Health

Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Complete Silver - EPO
Complete Silver + Vision + Adult Dental - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Premier Silver - EPO
Premier Silver + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO

Ambetter from Nebraska Total Care

Choice Bronze HSA - HMO
Choice Bronze HSA + Vision + Adult Dental - HMO
Clear Gold - HMO
Clear Gold + Vision + Adult Dental - HMO
Complete Silver - HMO
Complete Silver + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Gold - HMO
Elite Gold + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO

Ambetter from Sunflower Health Plan

Clear Silver - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO
Standard Silver + Vision + Adult Dental - EPO

Ambetter Health

Complete Gold - HMO
Complete Gold + Vision + Adult Dental - HMO
Elite Bronze - HMO
Elite Bronze + Vision + Adult Dental - HMO
Elite Silver - HMO
Elite Silver + Vision + Adult Dental - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO

Ambetter Health of Delaware

Clear Gold - EPO
Clear Gold + Vision + Adult Dental - EPO
Complete Gold - EPO
Complete Gold + Vision + Adult Dental - EPO
Elite Silver - EPO
Elite Silver + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO
Premier Bronze HSA - EPO
Premier Bronze HSA + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO

Ambetter of Illinois

Central Bronze - HMO
Central Bronze + Vision + Adult Dental - HMO
Central Gold - HMO
Central Gold + Vision + Adult Dental - HMO
Clear Silver - HMO
Everyday Bronze - HMO
Everyday Bronze + Vision + Adult Dental - HMO
Everyday Gold - HMO
Everyday Gold + Vision + Adult Dental - HMO
Focused Silver - HMO
Focused Silver + Vision + Adult Dental - HMO
Standard Expanded Bronze - HMO
Standard Expanded Bronze + Vision + Adult Dental - HMO
Standard Gold - HMO
Standard Gold + Vision + Adult Dental - HMO
Standard Silver - HMO
Standard Silver + Vision + Adult Dental - HMO

Ambetter of Oklahoma

Elite Bronze - PPO
Elite Bronze + Vision + Adult Dental - PPO
Elite Gold - PPO
Elite Gold + Vision + Adult Dental - PPO
Everyday Bronze - PPO
Everyday Bronze + Vision + Adult Dental - PPO
Everyday Gold - PPO
Everyday Gold + Vision + Adult Dental - PPO
Focused Silver - PPO
Focused Silver + Vision + Adult Dental - PPO
Standard Expanded Bronze - PPO
Standard Expanded Bronze + Vision + Adult Dental - PPO
Standard Gold - PPO
Standard Gold + Vision + Adult Dental - PPO
Standard Silver - PPO

Ambetter of Tennessee

Clear Silver - EPO
Elite Bronze - EPO
Elite Bronze + Vision + Adult Dental - EPO
Elite Gold - EPO
Elite Gold + Vision + Adult Dental - EPO
Enhanced Diabetes Care Silver with $0 Drug Options - EPO
Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
Everyday Bronze - EPO
Everyday Bronze + Vision + Adult Dental - EPO
Everyday Gold - EPO
Everyday Gold + Vision + Adult Dental - EPO
Focused Silver - EPO
Focused Silver + Vision + Adult Dental - EPO
Standard Expanded Bronze - EPO
Standard Expanded Bronze + Vision + Adult Dental - EPO
Standard Gold - EPO
Standard Gold + Vision + Adult Dental - EPO
Standard Silver - EPO
Standard Silver + Vision + Adult Dental - EPO

Anthem Blue Cross and Blue Shield

Anthem Bronze Pathway 6900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Bronze Pathway 7500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Bronze Pathway 9200 (+ Incentives) - EPO
Anthem Catastrophic Pathway 9200 (+ Incentives) - EPO
Anthem Gold Pathway 1500 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Heart Healthy Bronze Pathway 4900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Heart Healthy Silver Pathway 2900 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Silver Pathway 5000 Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Silver Pathway 5350 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO
Anthem Silver Pathway 7250 ($0 Virtual PCP + $0 Select Drugs + Incentives) - EPO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: SARA DEANE
Authorized Official Title: CHIEF FINANCIAL OFFICER
Authorized Official Phone: (573) 313-2500

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier	Type / Code	Identifier State	Identifier Issuer
500704036	MEDICAID (05)	MO

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number: 26D0924445
Facility Type: Physician Office
Certificate Effective Date: September 26, 2023
Certificate Expiration Date: September 25, 2025
Laboratory Director: DANIEL DOMJAN
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Otto Bean Medical Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	7	1	0	1	0	8	7	6	6
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	7	2	0	2	0	16	7	12
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 2 + 0 + 2 + 0 + 1 + 6 + 7 + 1 + 2 + 24 = 54
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 54 = 6									6

The NPI number 1710108766 is valid because the calculated check digit 6 using the Luhn validation algorithm matches the last digit of the original NPI number.