NPIMap

Individual provider Active NPI

C Mark Rose, D.O.

  • Family Medicine Physician
  • Richmond, MO
National Provider Identifier
1265408215
Registry record updated Jul 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R8G83 Issued in MO
Practice address
902 Wollard Blvd
Richmond, MO 64085
Phone
(816) 776-2201
Fax
(816) 776-7678
NPI assigned
Feb 28, 2006
Last updated
Jul 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R8G83 MO Primary

Addresses

Primary practice location

902 Wollard Blvd
Richmond, MO 64085

Mailing address

902 Wollard Blvd
Richmond, MO 64085
Phone (816) 776-2201

Other identifiers 2

IdentifierTypeStateIssuer
242411015MedicaidMO
13238051OtherMOBCBS

Other names 1

  • C Mark Rose Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040910001176 MO Practitioner - Family Practice 8527039171 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Kansas City University of Med & Biosciences, College of Osteo Med, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritas Health CorporationGroup PAC ID 6305748153, 492 clinicians

Practice addresses (Care Compare)

902 Wollard Blvd
Richmond, MO 64085-2229
Phone (816) 772-2201

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R8G83MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ray County Memorial Hospital CurrentSince Feb 1, 2026 Accepting new patients
Meritas Health Corporation CurrentSince Jun 1, 2016 Accepting new patients
Meritas Health Corporation CurrentSince Jun 1, 2016 Accepting new patients
Meritas Health Corporation Family Medicine Current Accepting new patients
Meritas Health Corporation Family Medicine Past Accepting new patients
Senior Citizens Nursing Home District of Ray County Past Accepting new patients
Meritas Health Corporation Family Medicine Past Accepting new patients

Locations

9411 N Oak Trfy
Ste LL1
Kansas City, MO 64155
Phone (816) 436-7072

2700 Clay Edwards Dr
Ste 240
North Kansas City, MO 64116
Phone (816) 455-0681

902 Wollard Blvd
Richmond, MO 64085
Phone (816) 772-2201

904 Wollard Blvd
Richmond, MO 64085
Phone (816) 470-5432

916 Wollard Blvd
Richmond, MO 64085
Phone (816) 333-2330

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1265408215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 WOLLARD BLVD",
            "city": "RICHMOND",
            "state": "MO",
            "postal_code": "64085",
            "telephone_number": "816-776-2201",
            "fax_number": "816-480-4515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 WOLLARD BLVD",
            "city": "RICHMOND",
            "state": "MO",
            "postal_code": "64085",
            "telephone_number": "816-776-2201",
            "fax_number": "816-776-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "C MARK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "R8G83",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242411015",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "13238051",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "C",
            "last_name": "ROSE",
            "middle_name": "MARK",
            "credential": "D.O.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Richmond, MO

Sources for this page

Verify at the official NPI Registry.