Individual provider Active NPI

James W Bernard, MD

  • Adult Medicine Physician
  • Caruthersville, MO
National Provider Identifier
1003923129
Registry record updated Apr 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
R2470 Issued in MO
Practice address
106 W 12TH St
Caruthersville, MO 63830-1890
Phone
(573) 333-1782
Fax
(573) 333-4665
NPI assigned
Aug 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X R2470 MO Primary

Addresses

Primary practice location

106 W 12TH St
Caruthersville, MO 63830-1890

Mailing address

PO Box 201
Caruthersville, MO 63830-0201
Phone (573) 333-1782

Other identifiers 1

IdentifierTypeStateIssuer
200063501MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pemiscot County Memorial Hospital Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428883200000",
    "number": "1003923129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638300201",
            "telephone_number": "573-333-1782",
            "fax_number": "573-333-4665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 W 12TH ST",
            "city": "CARUTHERSVILLE",
            "state": "MO",
            "postal_code": "638301890",
            "telephone_number": "573-333-1782",
            "fax_number": "573-333-4665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNARD",
        "first_name": "JAMES",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-24",
        "last_updated": "2015-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MO",
            "license": "R2470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200063501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caruthersville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.