NPIMap

Organization Active NPI

Table Rock Family Care Clinic, LLC

  • Rural Health Clinic/Center
  • Branson, MO
National Provider Identifier
1952934937
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TABLE ROCK FAMILY CARE CLINIC, LLC
Practice address
800 Highway 248 Ste F
Branson, MO 65616-4078
Phone
(417) 324-7672
NPI assigned
Feb 18, 2020
Last updated
Feb 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Charles S Rasmussen, DONPI 1891826269
Title
Physician
Phone
(417) 459-1323

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

800 Highway 248 Ste F
Branson, MO 65616-4078

Mailing address

800 Highway 248 Ste F
Branson, MO 65616-4078
Phone (417) 324-7672

Other names 1

  • Table Rock Family Care Clinic Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200401000365 MO Part A Provider - Rural Health Clinic 1052740750 Practice locations: Branson, MO
O20200424001330 MO Part B Supplier - Clinic/Group Practice 1052740750 Receives reassigned benefits from 4 practitioners
Practice locations: Branson, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952934937. Details of each certification follow.

Rural health clinic certification: CCN 793855

Legal name
TABLE ROCK FAMILY CARE CLINIC LLC
Doing business as
TABLE ROCK FAMILY MEDICINE AND OBSTETRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 4, 2020
Last certification
May 17, 2023
Ownership / control type
1A
Organization structure
LLCProprietary
Enrollment address
800 Highway 248
Ste F
Branson, MO 65616-4078

National Provider Directory

National Provider Directory

Locations

800 Highway 248
Ste F
Branson, MO 65616
Phone (417) 324-7672

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Charles S Rasmussen Individual 5% Or Greater Direct Ownership InterestD.O Mar 1, 2020 100%
W-2 Managing Employee Mar 1, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1581984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1952934937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 HIGHWAY 248 STE F",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656164078",
            "telephone_number": "417-324-7672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 HIGHWAY 248 STE F",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656164078",
            "telephone_number": "417-324-7672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABLE ROCK FAMILY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-18",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "RASMUSSEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "417-459-1323",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Table Rock Family Care Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Table Rock Family Care Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Branson, MO

Sources for this page

Verify at the official NPI Registry.