NPIMap

Organization Active NPI

Apollo Healthcare, LLC

  • Rural Health Clinic/Center
  • Farmington, MO
National Provider Identifier
1245545391
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
APOLLO HEALTHCARE, LLC
Practice address
1031 E Karsch Blvd
Farmington, MO 63640-3404
Phone
(573) 756-7880
Fax
(573) 756-2669
NPI assigned
Aug 13, 2010
Last updated
Sep 19, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Authorized official

Name
Amelia Doris Ledbetter
Title
Director
Phone
(573) 335-4715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

1031 E Karsch Blvd
Farmington, MO 63640-3404

Mailing address

PO Box 107
Farmington, MO 63640-0107
Phone (573) 756-7880

Other identifiers 1

IdentifierTypeStateIssuer
590121307MedicaidMO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110124000942 MO Part B Supplier - Clinic/Group Practice 4385823335 Receives reassigned benefits from 4 practitioners
Practice locations: Farmington, MO
O20120419000365 MO Part A Provider - Rural Health Clinic 4385823335 Practice locations: Farmington, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245545391. Details of each certification follow.

Rural health clinic certification: CCN 268945

Legal name
APOLLO HEALTHCARE, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 11, 2005
Last certification
Jul 29, 2024
Ownership / control type
1A
Most recent change of ownership
Jan 1, 2011 (1 total)
Organization structure
LLCProprietary
Enrollment address
1031 East Karsch Blvd
Farmington, MO 63640-3404

National Provider Directory

National Provider Directory
Tax ID family
Apollo Healthcare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Nilima P Chand Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2011 98%
W-2 Managing EmployeeOwner Jan 1, 2011
Sunita Chand Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2023 2%
W-2 Managing EmployeeOwner Jan 1, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1281657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1245545391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 107",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636400107",
            "telephone_number": "573-756-7880",
            "fax_number": "573-756-2669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 E KARSCH BLVD",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403404",
            "telephone_number": "573-756-7880",
            "fax_number": "573-756-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOLLO HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-13",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "LEDBETTER",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "DORIS",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "573-335-4715"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590121307",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.