NPIMap

Individual provider Active NPI

Thomas E Dahlberg, MD

  • Family Medicine Physician
  • Springfield, MO
National Provider Identifier
1013013093
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD104392 Issued in MO
Practice address
3322 S Campbell Ave Ste T-1
Springfield, MO 65807-4980
Phone
(417) 220-4480
Fax
(417) 414-0017
NPI assigned
Sep 16, 2006
Last updated
Jan 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD104392 MO Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X MD104392 MO

Addresses

Primary practice location

3322 S Campbell Ave Ste T-1
Springfield, MO 65807-4980

Mailing address

3322 S Campbell Ave Ste T-1
Springfield, MO 65807-4980
Phone (417) 220-4480

Other identifiers 4

IdentifierTypeStateIssuer
080170409OtherRR MEDICARE
207984428MedicaidMO
1013013093MedicaidMO
500128969MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090114000594 MO Practitioner - Family PracticePractitioner - Geriatric Medicine 6406919604 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Un of California, Irvine, College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

101 S Main St
Rogersville, MO 65742-9357
Phone (417) 753-9404

106 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110

108 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110

155 Village Dr
Sparta, MO 65753-8104
Phone (417) 634-4203

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD104392MOMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primrose Nephrology, Inc. Current Accepting new patients
Elite Professional Providers, LLC Family Medicine CurrentSince Jul 1, 2023 Accepting new patients
N & R of Strafford, Inc. Past Accepting new patients
N & R of Christian Republic LLC Past Accepting new patients
N & R of Hartville, LLC Past Accepting new patients
Forsyth Manor, Inc. Past Accepting new patients
N & R of Springfield West LLC Past Accepting new patients
N & R of Hollister, LLC Past Accepting new patients
N & R of Republic LLC Past Accepting new patients
N & R of Springfield Montclair LLC Past Accepting new patients
N & R of Brookhaven LLC Past Accepting new patients

Locations

1540 E Evergreen St
Springfield, MO 65803
Phone (417) 823-2900

2135 E Independence St
Springfield, MO 65804
Phone (305) 482-1494

3322 S Campbell Ave
Ste T1
Springfield, MO 65807
Phone (417) 220-4480

Networks

  • IL PPO Downstate
  • devoted network organization-2b183dd2-4e80-4977-80a6-4fdf0df4361d
  • IA HMO C-SNP
  • devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
  • devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
  • IA HMO

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
The Manor at ElfindaleSpringfield, MO, CCN 265804 Skilled nursing facility Contracted Managing Employee
Operational/Managerial Control		 Jan 1, 2022
Jan 1, 2022
Regional HospiceSpringfield, MO, CCN 261578 Hospice W-2 Managing Employee May 9, 2024
Preferred Hospice of MissouriColumbia, MO, CCN 261612 Hospice W-2 Managing Employee Oct 15, 2025
Preferred Hospice of Missouri SouthwestOzark, MO, CCN 261635 Hospice W-2 Managing Employee Mar 20, 2024

Owned or controlled facilities with NPI records 4

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

Organizations & group practices 12

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

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1013013093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 S CAMPBELL AVE STE T-1",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074980",
            "telephone_number": "417-220-4480",
            "fax_number": "417-900-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 S CAMPBELL AVE STE T-1",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658074980",
            "telephone_number": "417-220-4480",
            "fax_number": "417-414-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLBERG",
        "first_name": "THOMAS",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "MD104392",
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "MO",
            "license": "MD104392",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080170409",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207984428",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013013093",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500128969",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.