NPIMap

Organization Active NPI

Harrisonville Family Medicine, Inc.

  • Family Medicine Physician
  • Harrisonville, MO
National Provider Identifier
1891715652
Registry record updated Jan 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HARRISONVILLE FAMILY MEDICINE, INC.
Practice address
2820 E Rock Haven Rd
Suite 100
Harrisonville, MO 64701-4411
Phone
(816) 380-3582
Fax
(816) 380-6964
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2026

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

Authorized official

Name
Shaun Holden, M.D.NPI 1013933407
Title
President
Phone
(816) 380-3582

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Prosthetic/Orthotic Supplier 335E00000X MO

Addresses

Primary practice location

2820 E Rock Haven Rd
Suite 100
Harrisonville, MO 64701-4411

Mailing address

2820 E Rock Haven Rd
Suite 100
Harrisonville, MO 64701-4411
Phone (816) 380-3582

Other identifiers 3

IdentifierTypeStateIssuer
24999018OtherBLUE CROSS BLUE SHIELD
CS2185OtherRAILROAD MEDICARE
504598905MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050331001052 MO Part B Supplier - Clinic/Group Practice 2264489384 Receives reassigned benefits from 9 practitioners
Practice locations: Harrisonville, MO

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
26D0686085Harrisonville Family Medicine Inc2820 E Rock Haven Rd, Ste 100, Harrisonville, MO 64701Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

2800 E Rock Haven Rd
Ste 100
Harrisonville, MO 64701

2820 E Rock Haven Rd
Ste 120
Harrisonville, MO 64701
Phone (816) 380-2530

2820 E Rock Haven Rd
Ste 100
Harrisonville, MO 64701
Phone (816) 380-3582

2820 E Rock Haven Rd
Harrisonville, MO 64701
Phone (816) 380-2446

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14773/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768262400000",
    "number": "1891715652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 E ROCK HAVEN RD",
            "address_2": "SUITE 100",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "647014411",
            "telephone_number": "816-380-3582",
            "fax_number": "816-380-6964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 E ROCK HAVEN RD",
            "address_2": "SUITE 100",
            "city": "HARRISONVILLE",
            "state": "MO",
            "postal_code": "647014411",
            "telephone_number": "816-380-3582",
            "fax_number": "816-380-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISONVILLE FAMILY MEDICINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A",
        "authorized_official_last_name": "HOLDEN",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "816-380-3582",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "MO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "24999018",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS2185",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504598905",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisonville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.