OTTO BEAN MEDICAL CENTER
NPI 1710108766
Clinic/Center - Federally Qualified Health Center (FQHC) in Kennett, MO
About Otto Bean Medical Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
OTTO BEAN MEDICAL CENTER (NPI 1710108766) is a healthcare organization registered as a federally qualified health center (fqhc) in Kennett, Missouri and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through September 25, 2027 and lists Sara Deane, Chief Financial Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 2
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Otto Bean Medical Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
18Medicare enrollment records show 18 clinicians reassign Medicare billing to Otto Bean Medical Center, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 5
Clinicians, nearest first (18)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 26D0924445
Otto Bean Medical Center · Kennett, MOFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Southeast Missouri Health Network's NPI number?
The NPI number for Southeast Missouri Health Network is 1710108766. It was assigned to this organization in the NPPES registry on May 1, 2007. The provider is doing business as Otto Bean Medical Center. The provider is also known as Otto Bean Medical Clinic.
Where is Southeast Missouri Health Network located?
Southeast Missouri Health Network is located at 500 Russell St, Kennett, MO 63857. The listed phone number is (573) 717-1332.
What is Southeast Missouri Health Network's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Southeast Missouri Health Network enrolled in Medicare?
Yes. Southeast Missouri Health Network is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Southeast Missouri Health Network?
According to the CMS Revalidation Reassignment List (October 2026 release), 18 clinicians in 5 Medicare specialties reassign their Medicare billing to Southeast Missouri Health Network. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (11), Family Practice (3) and Mental Health Counselor (2). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Southeast Missouri Health Network hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 26D0924445) is associated with this NPI, valid through September 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Southeast Missouri Health Network accept?
Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Sunflower Health Plan and Ambetter of Oklahoma and 2 other insurers list Southeast Missouri Health Network as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Southeast Missouri Health Network was last updated on April 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Otto Bean Medical Center · NPI 1710108766
Federally Qualified Health Center (FQHC) organization in Kennett, Missouri. Organization record, active in the CMS NPPES registry since May 1, 2007.
## Identity
- **NPI:** 1710108766 (Entity type: Organization)
- **Enumerated:** May 1, 2007
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** Southeast Missouri Health Network
- **Also known as:** Otto Bean Medical Clinic (Other Name)
- **Organization subpart:** No
- **Authorized official:** Sara Deane, CHIEF FINANCIAL OFFICER
## Practice location
- **Address:** 500 RUSSELL ST, Kennett, MO 63857-2102
- **Phone:** (573) 717-1332 · **Fax:** (573) 717-1335
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 18 clinicians in 5 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (11), Family Practice (3), Mental Health Counselor (2); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 14, 2020
- **Other identifiers:** Medicaid 500704036 (MO)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710108766) · Data from the CMS NPPES public registry.