NPIMap

Organization Active NPI

McPherson Medical & Diagnostic, LLC

Doing business as Malden Family Clinic and Diagnostic

  • Clinic/Center
  • Malden, MO
National Provider Identifier
1003407883
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MCPHERSON MEDICAL & DIAGNOSTIC, LLC
Doing business as
Malden Family Clinic and Diagnostic
Practice address
1207 N Douglass St
Malden, MO 63863-1351
Phone
(573) 276-3884
Fax
(573) 276-3885
NPI assigned
Feb 3, 2021
Last updated
Feb 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Authorized official

Name
Timothy William McPherson, DONPI 1245264696
Title
Owner
Phone
(573) 695-2181

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1207 N Douglass St
Malden, MO 63863-1351

Mailing address

PO Box 12545
Belfast, ME 04915-4016
Phone (573) 276-3884

Other names 1

  • Malden Family Clinic and Diagnostic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061201000167 MO Part B Supplier - Clinic/Group Practice 5698773539 Receives reassigned benefits from 116 practitioners
23 other NPIs on this enrollment
Practice locations: Kennett, MO; Macon, MO; Malden, MO; Saint Louis, MO; Saint Peters, MO; Scott City, MO; Steele, MO; Moberly, MO…

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
26D2155570Malden Family Clinic and Diagnostic1207 N Douglass, Malden, MO 63863Certificate of waiverOct 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
American Medical Missouri37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Practitioners & affiliated clinicians

Practitioners 118

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 118

NPI Registry JSON

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612310400000",
    "number": "1003407883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12545",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154016",
            "telephone_number": "573-276-3884",
            "fax_number": "573-276-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 N DOUGLASS ST",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "638631351",
            "telephone_number": "573-276-3884",
            "fax_number": "573-276-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCPHERSON MEDICAL & DIAGNOSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A",
        "authorized_official_last_name": "MCPHERSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-695-2181",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malden Family Clinic and Diagnostic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Malden, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.