Vivian Dudley

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

142760 Issued in MO

Practice address

125 N Old Hwy 66
Bourbon, MO 65441

Phone

(573) 679-2006

Fax

(573) 679-2009

NPI assigned

Sep 26, 2006

Last updated

Aug 25, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Clinic East CommunitiesGroup PAC ID 7214827922, 573 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Rolla, MO, CCN 267098
• Mercy Hospital Washington Hospital, Washington, MO, CCN 260052

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
• Direct secure messaging: vdudley329651@directc.mercy.net

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.

• Mercy Clinic East Communities

  • Family Medicine Physician
  • Saint Louis, MO
  • NPI 1043574940

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Mercy Clinic East Communities

  • Rural Health Clinic/Center
  • Cuba, MO
  • NPI 1285998724
  NPD
• Mercy Clinic East Communities

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1851335228
  NPD
• Keith Turlington DPM PC

  dba Turlington Podiatry

  • Foot Surgery Podiatrist
  • Saint Louis, MO
  • NPI 1437259728
  NPD (past)
• Missouri Baptist Hospital of Sullivan

  dba Sullivan Medical Office

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1235228222
  NPD (past)
• Missouri Baptist Hospital of Sullivan

  dba Riverside Medical Clinic

  • Rural Health Clinic/Center
  • Sullivan, MO
  • NPI 1962591958
  NPD (past)

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

• Mercy Hospitals East Communities

  dba Mercy Hospital Washington

  • General Acute Care Hospital
  • Washington, MO
  • NPI 1285664177
  Care Compare affiliation
• Missouri Home Care of Rolla, Inc.

  dba CenterWell Home Health

  • Home Health Agency
  • Rolla, MO
  • NPI 1366495384
  Care Compare affiliation

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408924800000",
    "number": "1013018654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N OLD HWY 66",
            "city": "BOURBON",
            "state": "MO",
            "postal_code": "65441",
            "telephone_number": "573-679-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N OLD HWY 66",
            "city": "BOURBON",
            "state": "MO",
            "postal_code": "65441",
            "telephone_number": "573-679-2006",
            "fax_number": "573-679-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "VIVIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2014-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "142760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425076205",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013018654",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01134574",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barnabas Operations #2 (Barnabas Redwood Manor)
• Samantha Leann Birmingham
• Boulder Build Operations LLC Dba Barnabas Redwood Manor
• Bourbon Drugs Inc
• County of Crawford Public Schools
• Robyn Hedges
• Mark Williams Heywood, DC
• Alan D Lane, RPH
• John Wade McKinney, M.D.
• Medley Pharmacy Inc (LTC Sinks Pharmacy)

• Nurse Practitioner in Bourbon, MO
• Providers in Bourbon, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.