NPIMap

Organization Active NPI

Richland Medical Center, Inc.

Doing business as Central Ozark Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Osage Beach, MO
National Provider Identifier
1891931978
Registry record updated Oct 28, 2024
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 Ozark Medical Clinic
Practice address
3870 Columbia Ave
Osage Beach, MO 65065-8689
Phone
(573) 302-7490
NPI assigned
Dec 19, 2008
Last updated
Oct 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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 Primary

Addresses

Primary practice location

3870 Columbia Ave
Osage Beach, MO 65065-8689

Mailing address

PO Box 777
Richland, MO 65556-0777
Phone (573) 765-5131

Other names 1

  • CENTRAL OZARK MEDICAL CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100128000924 MO Part A Provider - Federally Qualified Health Center (FQHC) 2062554025 Practice locations: Osage Beach, MO
O20100525000793 MO Part B Supplier - Clinic/Group Practice 2062554025 Receives reassigned benefits from 79 practitioners
11 other NPIs on this enrollment
Practice locations: Eldon, MO; Waynesville, MO; Richland, MO; Osage Beach, MO; Lake Ozark, MO; Gravois Mills, MO; Crocker, MO; Camdenton, MO
O20240513001287 MO Part A Provider - Federally Qualified Health Center (FQHC) 2062554025 Practice locations: Richland, MO

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1891931978. Details of each certification follow.

Federally qualified health center certification: CCN 261039

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
Mar 17, 2010
Last certification
Mar 17, 2010
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
3870 Columbia Ave
Osage Beach, MO 65065-8689

Federally qualified health center certification: CCN 261986

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
May 29, 2024
Last certification
May 29, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1979 in MO
Enrollment address
304 W Washington Ave
Richland, MO 65556-7101

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
26D1090763Central Ozarks Medical Center3870 Columbia Ave, Osage Beach, MO 65065Certificate of waiverOct 16, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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, 2018
Corporate OfficerSecretary/Treasurer Jun 1, 2019
Bob Boatwright Individual Corporate DirectorChairperson Jan 1, 2011
Corporate Director Jan 1, 2019
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 DirectorBoard Member Jun 25, 2013
Corporate Director Jan 1, 2018
Angeline Hutton Individual Corporate DirectorBoard Member Jan 24, 2011
Carolyn Bowling Individual Corporate Director Jan 26, 2016
Krista Carter Individual Corporate Director Jan 1, 2011
Corporate Officer Jan 1, 2018
Robin Hobbs Individual Corporate Director Jan 26, 2016
Corporate Director Feb 1, 2018
Sherry Struckhoff Individual Corporate DirectorDirector Apr 15, 2015
Corporate OfficerVice Chairperson Aug 1, 2000
Teresa Kisling Individual Corporate Director Jan 1, 2018
Corporate Director May 1, 2000
Tom Reagan Individual Corporate Director Nov 24, 2015
Corporate OfficerChairperson Jun 1, 2000
Beth Wiles Individual Corporate Director Jan 1, 2018
Corporate Director Sep 1, 2000
Richland Medical Center, Inc. Organization, Richland, MO Corporation, Non-profit Operational/Managerial Control Dec 1, 2019
Kelly Miller Individual Operational/Managerial ControlCeo Jan 1, 2019

Owners & managing parties with NPI records 9

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

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 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

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 79

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.

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1229644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1891931978",
    "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": "573-765-5131",
            "fax_number": "573-765-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3870 COLUMBIA AVE",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650658689",
            "telephone_number": "573-302-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHLAND MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-19",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTRAL OZARK MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Osage Beach, MO

Sources for this page

Verify at the official NPI Registry.