NPIMap

Richland Medical Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Richland, MO

NPI 1679168306 · NPPES record last updated Jul 1, 2021

Key facts

NPI
1679168306
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
RICHLAND MEDICAL CENTER, INC
Practice address
112 W McClurg
Richland, MO 65556
Phone
(573) 765-5141
NPI assigned
Mar 4, 2021
Organization subpart
Yes
Parent organization (as reported)
RICHLAND MEDICAL CENTER, INC

Authorized official

Name
Kelly Miller
Title
Ceo
Phone
(573) 836-7071

Owners & managing parties with NPI records 9

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 11

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

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 13

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Federally qualified health center certification: CCN 791140

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
Jul 7, 2021
Last certification
Jul 7, 2021
Ownership / control type
For profit – corporation
Organization structure
LLC · Non-profit
Incorporated
Dec 1, 1991 in MO
Enrollment address
112 W McClurg Ave
Richland, MO 65556-7601

All disclosed owners & managing parties 13

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 Officer Jan 1, 2020
Bob Boatwright
Individual 		Corporate Officer Jan 1, 2020
Richland Medical Center, Inc.
Organization · Richland, MO
LLC 		Operational/Managerial Control Oct 1, 2019
David L Miller
Individual 		Corporate Officer Jan 1, 2020
Angeline Hutton
Individual 		Corporate Officer Jan 1, 2020
Carolyn Bowling
Individual 		Corporate Officer Jan 1, 2020
Robin Hobbs
Individual 		Corporate Officer Jan 1, 2020
Sherry Struckhoff
Individual 		Corporate Officer Jan 1, 2020
Tom Reagan
Individual 		Corporate Officer Jan 1, 2020
Elaine Clark
Individual 		Corporate Officer Jan 1, 2020
John W Parrish
Individual 		Corporate Officer Jan 1, 2020
Beth Wiles
Individual 		Corporate Officer Jan 1, 2020
Kelly Miller
Individual 		Corporate Officer Oct 1, 2019
W-2 Managing Employee Oct 1, 2019

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 Center
Camdenton, MO · CCN 261179		 Federally qualified health center Other (100%) Jan 1, 2019
Central Ozarks Medical Center
Richland, MO · CCN 261986		 Federally qualified health center Operational/Managerial Control Dec 1, 2019

Medicare enrollment records

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
O20210702000585 MO Part a Provider - Federally Qualified Health Center (FQHC) 2062554025 Practice locations: Richland, MO

National Provider Directory

Tax ID family
Richland Medical Center Inc (14 organizations share this tax ID)
Part of
Richland Medical Center Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 103TB0200X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 163WP0807X
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

112 W McClurg
Richland, MO 65556

Mailing address

PO Box 777
Richland, MO 65556-0777
Phone (573) 836-7053

Other names

  • Central Ozarks Medical Center Doing business as

Other providers in Richland, MO

All providers in Richland, MO · Federally Qualified Health Center (FQHC) in Missouri

Sources for this page

Verify at the official NPI Registry.