NPIMap

Organization Active NPI

Richland Medical Center, Inc.

Doing business as Central Ozarks Medical Center

  • Federally Qualified Health Center (FQHC)
  • Camdenton, MO
National Provider Identifier
1063985695
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RICHLAND MEDICAL CENTER, INC.
Doing business as
Central Ozarks Medical Center
Practice address
1652 N Business Route 5
Camdenton, MO 65020-6872
Phone
(573) 765-5131
Fax
(573) 765-3122
NPI assigned
Jan 7, 2019
Last updated
Feb 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Authorized official

Name
Paul Phillip Bocci, CPA
Title
Cfo
Phone
(314) 422-3617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1652 N Business Route 5
Camdenton, MO 65020-6872

Mailing address

PO Box 777
Richland, MO 65556-0777
Phone (573) 765-5131

Other names 1

  • Central Ozarks Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100525000793 MO Part B Supplier - Clinic/Group Practice 2062554025 Receives reassigned benefits from 79 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eldon, MO; Waynesville, MO; Richland, MO; Osage Beach, MO; Lake Ozark, MO; Gravois Mills, MO; Crocker, MO; Camdenton, MO
O20190926003164 MO Part A Provider - Federally Qualified Health Center (FQHC) 2062554025 Practice locations: Camdenton, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063985695. Details of each certification follow.

Federally qualified health center certification: CCN 261179

Legal name
RICHLAND MEDICAL CENTER, INC.
Doing business as
CENTRAL OZARKS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 25, 2019
Last certification
Sep 25, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1652 North Business Route 5
Camdenton, MO 65020-6872

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Richland Medical Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Brandon Witt Individual Corporate Director Jul 24, 2018
Bob Boatwright Individual Corporate Director May 23, 2017
Dawnelyn Schneider Individual Corporate OfficerCeo May 1, 2026
Corporate DirectorCeo May 1, 2026
W-2 Managing EmployeeCeo May 1, 2026
Richland Medical Center, Inc. Organization, Camdenton, MO Corporation, Non-profit Other Jan 1, 2019 100%
David L Miller Individual Corporate Director Jun 25, 2013
Angeline Hutton Individual Corporate Director Mar 24, 2015
Carolyn Bowling Individual Corporate Director Jan 26, 2016
Krista Carter Individual Corporate Director Jun 1, 2018
Robin Hobbs Individual Corporate Director Jan 26, 2016
Sherry Struckhoff Individual Corporate DirectorVice Chairperson Apr 28, 2015
Teresa Kisling Individual Corporate Director Jan 1, 2018
Tom Reagan Individual Corporate DirectorChairperson Nov 24, 2015
Elaine Clark Individual Corporate Director Mar 24, 2015
John W Parrish Individual Corporate Director Jun 1, 2011
Beth Wiles Individual Corporate Director Jun 26, 2018

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Central Ozarks Medical CenterRichland, MO, CCN 791140 Federally qualified health center Operational/Managerial Control Oct 1, 2019
Central Ozarks Medical CenterRichland, MO, CCN 261986 Federally qualified health center Operational/Managerial Control Dec 1, 2019

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1546819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550707200000",
    "number": "1063985695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 777",
            "city": "RICHLAND",
            "state": "MO",
            "postal_code": "655560777",
            "telephone_number": "573-765-5131",
            "fax_number": "573-765-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1652 N BUSINESS ROUTE 5",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "650206872",
            "telephone_number": "573-765-5131",
            "fax_number": "573-765-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHLAND MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-07",
        "last_updated": "2019-02-21",
        "status": "A",
        "authorized_official_last_name": "BOCCI",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-422-3617",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Ozarks Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Central Ozarks Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Camdenton, MO

Sources for this page

Verify at the official NPI Registry.