NPIMap

Organization Active NPI

Richland Medical Center, Inc.

Doing business as Central Ozarks Medical Center

  • Federally Qualified Health Center (FQHC)
  • Gravois Mills, MO
National Provider Identifier
1881347086
Registry record updated Jan 28, 2022
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
401 N Main St
Gravois Mills, MO 65037-6253
Phone
(877) 406-2662
Fax
(573) 765-3122
NPI assigned
Jan 28, 2022
Last updated
Jan 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

401 N Main St
Gravois Mills, MO 65037-6253

Mailing address

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

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
O20220908002279 MO Part A Provider - Federally Qualified Health Center (FQHC) 2062554025 Practice locations: Gravois Mills, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881347086. Details of each certification follow.

Federally qualified health center certification: CCN 261912

Legal name
RICHLAND MEDICAL CENTER, INC.
Doing business as
CENTRAL OZARKS MEDICAL CENTER - LAURIE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 26, 2022
Last certification
Aug 26, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
401 N Main St
Gravois Mills, MO 65037-6253

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D2258714Central Ozarks Medical Center - Laurie401 N Main Street, Gravois Mills, MO 65037Certificate of waiverApr 25, 2028

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 11

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 Jan 1, 2022
Bob Boatwright Individual Corporate Director Jan 1, 2022
Dawnelyn Schneider Individual Corporate OfficerCeo May 1, 2026
Corporate DirectorCeo May 1, 2026
W-2 Managing EmployeeCeo May 1, 2026
David L Miller Individual Corporate Director Jan 1, 2022
Angeline Hutton Individual Corporate Director Jan 1, 2022
Krista Carter Individual Corporate Director Jan 1, 2022
Robin Hobbs Individual Corporate Director Jan 1, 2022
Sherry Struckhoff Individual Corporate Director Jan 1, 2022
Teresa Kisling Individual Corporate Director Jan 1, 2022
Tom Reagan Individual Corporate Director Jan 1, 2022
Beth Wiles Individual Corporate Director Jan 1, 2022

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Central Ozarks Medical CenterCamdenton, MO, CCN 261179 Federally qualified health center Other (100%) Jan 1, 2019
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 3

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

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": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1881347086",
    "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": "573-836-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N MAIN ST",
            "city": "GRAVOIS MILLS",
            "state": "MO",
            "postal_code": "650376253",
            "telephone_number": "877-406-2662",
            "fax_number": "573-765-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHLAND MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-836-7071"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Ozarks Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gravois Mills, MO

Sources for this page

Verify at the official NPI Registry.