McPherson Medical & Diagnostic, LLC
Organization Active NPI Clinic/Center · Malden, MO
NPI 1003407883 · NPPES record last updated Feb 3, 2021
Key facts
- NPI
- 1003407883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- MCPHERSON MEDICAL & DIAGNOSTIC, LLC
- Practice address
- 1207 N Douglass St
Malden, MO 63863-1351 - Phone
- (573) 276-3884
- Fax
- (573) 276-3885
- NPI assigned
- Feb 3, 2021
- Organization subpart
- No
Authorized official
- Name
- Timothy William McPherson, DO
- Title
- Owner
- Phone
- (573) 695-2181
Other NPIs on the same Medicare enrollment 23
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 36
Practitioners 123
-
Naser Almasalmeh, M.D.
-
Abdullah Arshad, MD
-
Melinda Susan Auer, M.D.
-
Jordan Brotz, FNP
-
Shawn K Brunk, DO
-
Laurell A Conder, NP-C
-
James L Deline, M.D.
-
Crystal Joy Dyer, FNP-C
-
Shellee Flora, FNP
-
Kayla Leann Fuller, MSN, APRN, FNP-BC
-
Connie Lynne Gurley, APRN-BC, FNP
-
Joseph Hazan, MD
-
Crystal Gail Jackson, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2155570 | Malden Family Clinic and Diagnostic | Certificate of waiver | Oct 1, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- McPherson Medical Diagnostic LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
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
- Malden Family Clinic and Diagnostic
Other providers in Malden, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.